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We would like to thank Drs Polat and Gumus for their interest in our study. First, we used infraclavicular brachial plexus block for arteriovenous fistula surgery because this approach is one of the most recommended regional techniques. In addition to this technique, use of ultrasound increases the success rate and quality of the block. Our success rate (93.4%) is similar to that in the literature.1Gürkan Y. Tekin M. Acar S. Solak M. Toker K. Is nerve stimulation needed during an ultrasound-guided lateral sagittal infraclavicular block?.Acta Anaesthesiol Scand. 2010; 54: 403-407Crossref PubMed Scopus (27) Google Scholar Interscalene block is well suited for surgical procedures involving the shoulder, clavicula, proximal humerus, and shoulder joint, but incomplete blockage of the inferior trunk often results in insufficient analgesia in the ulnar distribution for forearm surgery. Thus, we can say that interscalene block is not suitable every time and may result in a lower success rate of block for forearm surgery, as in their previous study. In the interscalene approach, there is a high risk of hemidiaphragmatic paralysis because phrenic nerve neighborhood with brachial plexus in that area. But there is not a similar risk in infraclavicular block, and the risk of pneumothorax is minimized by ultrasound. In conclusion, we have not encountered respiratory distress in any patient. In our study, primary patency and primary failure rates (7% vs 17%) are significantly different between the two groups. Mouquet et al2Mouquet C. Bitker M.O. Bailliart O. Rottembourg J. Clergue F. Montejo L.S. et al.Anesthesia for creation of a forearm fistula in patients with endstage renal failure.Anesthesiology. 1989; 70: 909-914Crossref PubMed Scopus (55) Google Scholar reported that, after brachial plexus block, brachial artery diameter and blood flow, as well as arteriovenous fistula blood flow, increased compared with controls. The incorporation of various brachial plexus block techniques in arteriovenous fistula construction thus appears to contribute to vessel dilation and reduced vasospasm by sympathectomy-like effects and may improve the success of vascular access procedures by significantly increasing fistula blood flow. The use of a regional block, compared with other anesthetic techniques such as infiltration and general anesthesia, have been shown to result in higher patency rates and lower failure rates.3Shemesh D. Olsha O. Orkin D. Raveh D. Goldin I. Reichenstein Y. et al.Sympathectomy-like effects of brachial plexus block in arteriovenous access surgery.Ultrasound Med Biol. 2006; 32: 817-822Abstract Full Text Full Text PDF PubMed Scopus (57) Google Scholar Regarding “Ultrasound-guided infraclavicular brachial plexus block enhances postoperative blood flow in arteriovenous fistulas”Journal of Vascular SurgeryVol. 55Issue 4PreviewWe have read the interesting article about the infraclavicular brachial plexus block by Sahin, and colleagues.1 This is a well-designed and analyzed study. We have a few questions in order to clarify some important points about the subject. The most important fact is the success rate. The authors reported a 93.4% success rate in their series. In a previous study of ours,2 we had an 80.9% success rate, which was comparable to the literature.3 Of the bupivacaine group in our study,2 three patients of 16 required supplemental local analgesic, which is higher than the authors' study. Full-Text PDF Open Archive