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

Başkan, Semih; Vural, Çağıl; Erdogmus, Necati A; Aytaç, İsmail

doi:10.1016/j.bjane.2021.12.008

Cited by 3 publications

(3 citation statements)

References 22 publications

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“…However, few studies showed that there was no significant difference in terms of effect time between patients who received bupivacaine alone compared to those who received bupivacaine plus lidocaine. (Başkan et al, 2022;Gunjiyal et al, 2021)Our study findings are inconsistent with these as in our study; there was a significant difference between the two groups.…”

Section: Discussioncontrasting

confidence: 96%

Comparison of Bupivacaine Alone and Bupivacaine Plus Lidocaine in Supraclavicular Block Under Ultrasound Guidance

SAEED,

RABIA,

BUKHARI

et al. 2023

Biol Clin Sci Res J

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This study aimed to compare the effectiveness of bupivacaine alone versus bupivacaine combined with lidocaine in patients undergoing ultrasound-guided supraclavicular block. Specifically, the study focused on the onset time and duration of the block effect. The study was designed as a retrospective study in the anesthesia room of the operation theater of Sheikh Zayed Hospital, Lahore, from 2nd November 2021 to 1st May 2022. A total of 200 patients who met the inclusion criteria were included in the study. Prior to the intervention, patients were given midazolam (2mg) to help alleviate anxiety. The participants were then divided into two groups, with 100 patients in each group. Group A received bupivacaine 20 ml (5 mg/ml), while Group B received bupivacaine 10 ml (5 mg/ml) in combination with lidocaine 10 ml (20 mg/ml). The onset and block effect times were recorded in a Performa and subjected to statistical analysis. The results of the study showed that the mean block onset time in Group A (bupivacaine alone) was 9.4±1.34 minutes, while in Group B (bupivacaine plus lidocaine), the mean block onset time was 5.4±0.83 minutes (p=0.000). A comparison of the mean block effect time revealed that in Group A, the mean block effect time was 4±1.34 minutes, while in Group B, the mean block effect time was 6±0.83 minutes. This difference was found to be statistically significant (p=0.000). In conclusion, the study demonstrated that the combination of bupivacaine plus lidocaine was significantly associated with a shorter block onset time and a longer block effect time compared to bupivacaine alone.

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Section: Discussioncontrasting

confidence: 96%

Comparison of Bupivacaine Alone and Bupivacaine Plus Lidocaine in Supraclavicular Block Under Ultrasound Guidance

SAEED,

RABIA,

BUKHARI

et al. 2023

Biol Clin Sci Res J

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“…[ 16 ] Another study found 14 mL as the minimum effective volume (MEV) for 0.5% bupivacaine, albeit with a longer onset time of 40 minutes in the USG-guided classical ICB approach. [ 17 ] Tran et al . [ 18 ] established the MEV90 for ultrasound-guided classical ICB as 35 ml using 1.5% lidocaine with 5 µg/mL epinephrine.…”

Section: Discussionmentioning

confidence: 99%

Comparison of the classical approach and costoclavicular approach of ultrasound-guided infraclavicular block: A systematic review and meta-analysis

Garg,

Makhija,

Jain

et al. 2024

Indian Journal of Anaesthesia

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Background and Aims: The infraclavicular brachial plexus block (ICB) provides analgesia and anaesthesia of the upper limb. It is given using the classical or the more recently described costoclavicular (CC) approach at the level of cords. This systematic review aimed to assess which approach is better for the ICB in terms of onset, performance, and safety. Methods: This PROSPERO (vide registration number CRD42022361636) registered meta-analysis included randomised trials of patients undergoing upper limb surgery in ultrasound-guided ICB from MEDLINE, EMBASE, SCOPUS, and IRCTP from inception to March 2023. The quality of evidence was assessed using GradePro software. The primary outcomes were sensory and motor block onset time and the number of patients having complete block at 30 minutes. Secondary outcomes included block performance time (BPT), number of attempts, duration of the block, and any incidence of complications. Results: Five trials with 374 adult patients (classic = 185, CC = 189) were included. No significant difference was found in the sensory (Mean difference (MD): 1.44 minutes [95% confidence interval (CI): 3.06, 5.95]; I2 = 95%; very low level of evidence (LOE); P = 0.53) and motor block onset times (MD: 0.83 minutes [95% CI: 0.96, 2.62]; I2 = 84%; very low LOE P = 0.36) and BPT (MD: 5.06 seconds [95% CI: 38.50, 48.63]; I2 = 98%; very low LOE; P = 0.82) in classic and CC approach of ICB. Trial sequential analysis revealed our sample size to be 0.65% of the required sample size to achieve 80% power, deeming our study underpowered. Conclusion: Costoclavicular approach was not superior or inferior to the classical technique for infraclavicular brachial plexus block. However, the quality of evidence is low and further studies are needed to corroborate the findings.

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“…19 20 Similarly, in a dose-finding study on infraclavicular BPB, Baskan et al demonstrated that reducing the volume of 0.5% bupivacaine from 30 mL to 14 mL (MELAV) increased the block onset time from 15 min to 40 min (r=−0.089). 21 Hence, increasing the bupivacaine volume to 30 mL or using concentration more than 0.5% in 20 mL volume might have changed the block onset time.…”

Section: Original Researchmentioning

confidence: 99%

Equal mixture of 2% lidocaine with adrenaline and 0.5% bupivacaine 20 mL provided faster onset of complete conduction blockade during ultrasound-guided supraclavicular brachial plexus block than 20 mL of 0.5% bupivacaine alone: a randomized double-blinded clinical trial

Sripriya¹,

Sivashanmugam²,

Rajadurai³

et al. 2023

Reg Anesth Pain Med

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IntroductionRecent evidence has questioned the advantage of local anesthetic (LA) combinations. This study tested the hypothesis that mixing rapid-onset (lidocaine) and long-duration (bupivacaine) LA would provide faster onset of complete conduction blockade (CCB) compared with bupivacaine alone and longer duration of analgesia compared with lidocaine alone during low-volume (20 mL) ultrasound-guided (USG) supraclavicular brachial plexus block (SCBPB).MethodsSixty-three patients receiving USG-SCBPB were randomly allocated into: groupL: 20 mL 2% lidocaine with epinephrine 1:200 000;group B:20 mL 0.5% bupivacaine;group LB: 20 mL of equi-volume mixture of both drugs. Sensory and motor blockade was recorded on a three point sensory and motor assessment scale at 10 min intervals for up to 40 min and the total composite score (TCS) at each time point was determined. The duration of analgesia was also noted.ResultsThe mean time to CCB of group LB (16±7 min) was comparable (p>0.05) with group L (14±6 min) and group B (21±8 min) in patients who were attained CCB. However, the proportion of patients attaining complete conduction block (TCS=16/16) was significantly lower (p=0.0001) in group B (48%) when compared with group L (95%) and group LB (95%) at the end of 40 min. The median (IQR) duration of postoperative analgesia was longest in group B; 12.2 (12–14.5) hours, followed by group LB 8.3 (7–11) hours and 4 (2.7–4.5) hours in group L.ConclusionAt 20 mL LA volume, equal mixture of lidocaine and bupivacaine provided significantly faster onset of CCB compared with bupivacaine alone and longer duration of postoperative analgesia compared with lidocaine alone but shorter than bupivacaine alone during low-volume USG-SCBPB.Trial registration numberCTRI/2020/11/029359.

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

Cited by 3 publications

References 22 publications

Comparison of Bupivacaine Alone and Bupivacaine Plus Lidocaine in Supraclavicular Block Under Ultrasound Guidance

Comparison of Bupivacaine Alone and Bupivacaine Plus Lidocaine in Supraclavicular Block Under Ultrasound Guidance

Comparison of the classical approach and costoclavicular approach of ultrasound-guided infraclavicular block: A systematic review and meta-analysis

Equal mixture of 2% lidocaine with adrenaline and 0.5% bupivacaine 20 mL provided faster onset of complete conduction blockade during ultrasound-guided supraclavicular brachial plexus block than 20 mL of 0.5% bupivacaine alone: a randomized double-blinded clinical trial

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