Fifty patients with end-stage renal disease on hemodialysis undergoing major lower-limb orthopedic surgery were randomized to receive ultrasound-guided stellate ganglion block (SGB) with 7.5 mL bupivacaine 0.25% before spinal anesthesia (n=25) or a sham procedure without stellate injection (n=25). The primary outcome of interest was AVF flow rate (Doppler) on postoperative days 1 and 7. Secondary outcomes of interest included peak systolic velocity (PSV), end-diastolic velocity (EDV), resistive index (RI), thrombosis, functional failure, and adverse events. Outcomes were assessed at postoperative days 1 and 7, with functional use followed to 6 weeks. Overall, the results of the study revealed higher AVF flow, higher PSV/EDV, lower RI (day 1), and lower thrombosis and functional failure with SGB. These findings suggest perioperative SGB may help maintain AVF patency in this setting.