Minimum effective volume of bupivacaine 0.5% for ultrasound-guided retroclavicular approach to infraclavicular brachial plexus block

Kavakli, Ali Sait; Öztürk, Nilgün; Arslan, Ulku Yalcintas

doi:10.1016/j.bjane.2018.12.011

Cited by 4 publications

(6 citation statements)

References 14 publications

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“…In a study that decreased the volume of 0.5% bupivacaine to 1 mL for each nerve, 12 50% of patients had a successful block and the MEV was 9.6 mL. 6 …”

Section: Discussionmentioning

confidence: 99%

“…Few studies have investigated the MEV of bupivacaine. 6 , 12 Tran et al 7 reported that 90% of patients administered 1.5% lidocaine had successful brachial plexus block and the MEV was 30 mL. Although lidocaine and bupivacaine are amino-amide anesthetics, bupivacaine is more potent owing to its higher lipid solubility and may be administered in lower concentrations (usually 0.5% bupivacaine vs. 2% lidocaine).…”

Section: Discussionmentioning

confidence: 99%

“…Few studies have determined the MEVs of various LAs administered with various anatomical approaches for USG infraclavicular brachial plexus block. 6 , 7 , 12 , 25 Although the methodologies and results of these studies differ, the aims were similar: to reduce the dose of LA administered for brachial plexus block. We concluded that brachial plexus block can be successfully performed with a low bupivacaine dose, albeit with a long time of onset.…”

Section: Discussionmentioning

confidence: 99%

“…To our knowledge, few studies have investigated the MEVs of various LAs administered for infraclavicular blocks with different approaches. 6 7 We aimed to determine the MEV of bupivacaine for ultrasound-guided (USG) infraclavicular brachial plexus block.…”

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Determination of the minimum effective volume of bupivacaine for ultrasound-guided infraclavicular brachial plexus block: a prospective, observer-blind, controlled study

Başkan

Vural

Erdogmus

et al. 2022

Brazilian Journal of Anesthesiology (English Edition)

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“…In a study that decreased the volume of 0.5% bupivacaine to 1 mL for each nerve, 12 50% of patients had a successful block and the MEV was 9.6 mL. 6 …”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Determination of the minimum effective volume of bupivacaine for ultrasound-guided infraclavicular brachial plexus block: a prospective, observer-blind, controlled study

Başkan

Vural

Erdogmus

et al. 2022

Brazilian Journal of Anesthesiology (English Edition)

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“…However, the 90% MEV (MEV90) of ropivacaine for caudal block in anorectal surgery is unknown in adults. MEV90 is a more precise reference for the application of sacral block to local anesthesia in anorectal surgery than MEV50 ( 3 , 12 ). Therefore, the current study was designed to investigate the MEV90 of 0.5% ropivacaine for US-guided CEB in adults undergoing anorectal surgery using a biased coin design UDM.…”

Section: Introductionmentioning

confidence: 99%

Study on MEV90 of 0.5% ropivacaine for US-guided caudal epidural block in anorectal surgery

Zhang

Chen²,

Yang³

et al. 2023

Front. Med.

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BackgroundChoosing the appropriate concentration and volume of anesthetics is critical for a successful nerve block. The current study aimed to determine the minimum effective volume (MEV) of 0.5% ropivacaine for US-guided CEB in 90% of patients (MEV90) undergoing anorectal surgery. The aims were to reduce the occurrence of complications associated with a sacral blockade in anorectal surgery, broaden the indications for surgical procedures and treatment, and improve patient satisfaction. This study presents the groundwork for the development of individualized anesthetic programs. We believe that the study would serve as a reference for the use of caudal epidural block (CEB) in lower abdominal surgery for intraoperative and postoperative analgesia.MethodsThis study used a biased coin design (BCD) up-and-down method (UDM). We divided the participants into two groups based on gender, and each group independently performed the biased coin design up-and-down method. We used 0.5% ropivacaine for the first patient in each group; however, the volume was 10 ml for men and 8 ml for women. Therefore, the dose of anesthetics given to each patient was determined by the response of the previous patient. If the block of the previous patient failed, the volume was increased by 2 ml in the following patient. Otherwise, the next subject had an 11% chance of receiving a volume of 2 ml less or an 89% chance of receiving no volume change. We defined a successful block as painless surgery with anal sphincter relaxation 15 min after the drug injection. Enrollment was completed after 45 successful caudal blocks for each group.ResultsCaudal epidural block was successfully performed on 50 men and 49 women. The MEV90 of ropivacaine for CEB was calculated to be 12.88 ml (95% CI: 10.8–14 ml) for men and 10.73 ml (95% CI: 9.67–12 ml) for women. Men had a MEV99 of 13.88 ml (95% CI: 12.97–14 ml), and women had a MEV99 of 11.87 ml (95% CI: 11.72–12 ml).ConclusionWith operability and general applicability, it is possible to increase the success rate of CEB for anorectal surgery to 99% as well as decrease the incidence of anesthesia-related complications. CEB can meet the needs of patients for rapid postoperative rehabilitation, improve patient satisfaction, and lay a solid foundation for postoperative analgesia.

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The Minimum Effective Concentration (MEC95) of different volumes of ropivacaine for ultrasound-guided caudal epidural block: a dose-finding study

Chen

et al. 2023

BMC Anesthesiol

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Background Caudal epidural block (CEB) may be beneficial in anorectal surgery because its use may extend postoperative analgesia. This dose-finding study aimed to estimate the minimum effective anesthetic concentrations for 95% patients(MEC95) of 20 ml or 25 ml of ropivacaine in with CEB. Patients and methods In this double-blind, prospective study, the concentration of ropivacaine administered in 20 ml and 25 ml for ultrasound-guided CEB were determined using the sample up-and-down sequential allocation study design of binary response variables. The first participant was given 0.5% ropivacaine. Depending on whether a block was successful or unsuccessful, the concentration of local anesthesia was decreased or increased by 0.025% in the next patient. Every five minutes for 30 min, the sensory blockade using a pin-prick sensation at S3 dermatome compared to at T6 dermatome were evaluated every 5 min within 30 min. An effective CEB was defined as a a reduction of sensation at S3 dermatome and the existence of flaccid anal sphincter. Anesthesia was considered successful if the surgeon could perform the surgery without additional anesthesia. We determined the MEC50 using the Dixon and Massey up-and-down method and estimated the MEC95 using probit regression. Results The concentration of ropivacaine administered in 20 ml for CEB ranged from 0.2% to 0.5%. Probit regression with a bias-corrected Morris 95% CI derived by bootstrapping showed an MEC50 and MEC 50 of ropivacaine for anorectal surgical anesthesia were 0.27% (95% CI, 0.24 to 0.31) and 0.36%(95% CI, 0.32 to 0.61). The concentration of ropivacaine administered in 25 ml for CEB ranged from 0.175 to 0.5. Probit regression with a bias-corrected Morris 95% CI derived by bootstrapping showed an MEC50 and MEC95 for CEB were 0.24% (95% CI, 0.19 to 0.27) and 0.32% (95% CI, 0.28 to 0.54). Conclusion With ultrasound-guided CEB, the MEC95 of 0.36% ropivacaine at 20 ml and 0.32% ropivacaine at 25 ml provide adequate surgical anesthesia/analgesia 95% of patients undergoing anorectoal surgery. Trial registration Clinicaltrails.gov: Retrospectively registered (ChiCTR2100042954; Registration date:1/2, 2021).

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Minimum effective volume of bupivacaine 0.5% for ultrasound-guided retroclavicular approach to infraclavicular brachial plexus block

Cited by 4 publications

References 14 publications

Determination of the minimum effective volume of bupivacaine for ultrasound-guided infraclavicular brachial plexus block: a prospective, observer-blind, controlled study

Determination of the minimum effective volume of bupivacaine for ultrasound-guided infraclavicular brachial plexus block: a prospective, observer-blind, controlled study

Study on MEV90 of 0.5% ropivacaine for US-guided caudal epidural block in anorectal surgery

The Minimum Effective Concentration (MEC95) of different volumes of ropivacaine for ultrasound-guided caudal epidural block: a dose-finding study

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