Abstract
Abstract Background Balloon angioplasty for forearm arteriovenous fistula (AVF) often provokes substantial pain during inflation. Objective To compare an ultrasound-guided suprafascial plane block (SFPB) with brachial plexus block (BPB) during forearm AVF percutaneous transluminal angioplasty (PTA), focusing on analgesic effectiveness and safety. Methods Single-center, retrospective comparative study (January 1–December 31, 2025) of consecutive adults with forearm radiocephalic AVFs. SFPB targeted the superficial fascia–deep adipose tissue (SF–DAT) interface after sheath placement and guidewire traversal; BPB was completed before venipuncture. The primary endpoint was peak-inflation pain on the numeric rating scale (NRS, 0–10). Secondary outcomes included rescue analgesia, procedure time, block-related complications, and short-term patency. Results We analyzed SFPB (n = 32) and BPB (n = 35). The primary endpoint favored BPB (mean peak-inflation NRS 1.54 ± 0.74 vs. 2.66 ± 0.85; mean difference − 1.12, 95% CI − 1.51 to − 0.73; p = 0.0038). Importantly, SFPB achieved the prespecified analgesic adequacy threshold (NRS ≤ 3) in 87.5% of patients (28/32) with no rescue analgesia, no conversion, and no transient motor block. By contrast, BPB caused universal transient motor block and hoarseness in 2 patients. Procedure time was similar between groups (70.77 ± 37.51 vs. 87.49 ± 36.21 min; p = 0.0613). One- and three-month primary patency was 100% in both groups. Conclusions This retrospective study shows that SFPB provides clinically adequate, motor-sparing analgesia suitable for outpatient forearm AVF–PTA, while BPB yields better pain control but causes universal transient motor block. SFPB may be considered a pragmatic, image-standardizable option for selected patients. These findings are preliminary; prospective trials are needed to confirm efficacy and safety.