**2.1 Local anesthesia**

Infiltration of LA in the surgical field by the surgeon provides stable analgesia with minimal to no hemodynamic and respiratory changes and is, therefore, often used in patients who have severe cardiopulmonary co-morbidities. The specific LA selected depends on the surgeon's preference, but many surgeons prefer 1% lidocaine as the onset is faster compared to others. In some patients experiencing agitation or anxiety during the procedure, LA alone is not well tolerated. This situation should be overcome with additional sedation and/or analgesia such as propofol infusion or fentanyl provided by the anesthesia team. The other problem for LA is the lack of a preventive effect on the spasm of the artery, in contrast to RA and GA. Previous reports have revealed that the use of a brachial plexus block with a supraclavicular approach provided dilatation of both the veins and arteries of the ipsilateral extremity immediately following the block, reduced the incidence of arterial spasm during and after the surgery, and significantly decreased the rate of immediate AVF failure postoperatively when compared to those that were performed with LA [6–8].
