Objective To compare the safety and efficacy of various brachial plexus block techniques using local anesthesia （LA） in patients undergoing their first radiocephalic arteriovenous fistula （RCAVF） surgery. Methods Patients were randomly allocated into three groups： LA， interscalene brachial plexus block （ISBPB）， and axillary brachial plexus block （ABPB）. Ultrasound was utilized to evaluate the pre- and post-anesthesia changes in vessel diameter and blood flow. Postoperative follow-up assessments were performed at three days and three months to determine fistula patency. Results Immediate patency rates were 92.52% （LA）， 96.26% （ISBPB）， and 95.33% （ABPB）， with no statistically significant differences among the groups （χ2 = 1.615， P = 0.446）. However， at three months， primary patency rates differed significantly among the groups （χ2 = 22.691， P < 0.001）. Specifically， the ISBPB group （83.18%） exhibited significantly higher patency compared to the LA group （57.01%） （χ2 = 17.477， P < 0.001）. Similarly， the ABPB group （80.37%） demonstrated better patency than the LA group （χ2 = 13.580， P < 0.001）. Regarding respiratory complications， they were more prevalent in the ISBPB group （15.89%） compared to the LA group （2.80%） （χ2 = 9.761， P = 0.002） and the ABPB group （0.93%） （χ2 = 14.377， P < 0.001）. No significant difference was observed between the LA and ABPB groups in terms of respiratory complications （χ2 = 1.019， P = 0.313）. Conclusions Both ISBPB and ABPB demonstrated superior primary patency compared to LA. Nevertheless， ABPB exerted a lesser impact on respiratory function and provided a more comfortable surgical experience for ESRD patients.