Median Effective Volume of 0.5% Ropivacaine for Ultrasound-guided Costoclavicular Block

Kewlani, Anu; Bhatia, Nidhi; Makkar, Jeetinder Kaur; Kumar, Vishal

doi:10.1097/aln.0000000000003731

Cited by 11 publications

(12 citation statements)

References 22 publications

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“…According to previous dose-finding studies of CCB, approximately 20 ml of local anesthetic is required for surgical anesthesia in forearm and hand surgeries [24,25]. Since even twice the volume of injectate during CCB showed no significant improvement in supraclavicular spreading in the current study, other factors affecting proper coverage of the shoulder joint should be considered.…”

Section: Incomplete Analgesiamentioning

confidence: 80%

Effect of local anesthetic volume (20 vs. 40 ml) on the analgesic efficacy of costoclavicular block in arthroscopic shoulder surgery: a randomized controlled trial

Jo,

Oh,

Lee

et al. 2024

Korean J Anesthesiol

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Background: Among the various diaphragm-sparing alternatives to interscalene block, costoclavicular block (CCB) demonstrated a low hemidiaphragmatic paresis (HDP) occurrence but an inconsistent analgesic effect in arthroscopic shoulder surgery. We hypothesized that a larger volume of local anesthetic for CCB could provide sufficient analgesia by achieving sufficient supraclavicular spreading.Methods: Sixty patients scheduled for arthroscopic rotator cuff repair were randomly assigned to receive CCB using one of two volumes of local anesthetic (CCB20, 0.75% ropivacaine 20 ml; CCB40, 0.375% ropivacaine 40 ml). The primary outcome was the rate of complete analgesia (0 on the numeric rating scale of pain) at 1 h postoperatively. The secondary outcomes included a sonographic assessment of local anesthetic spread, diaphragmatic function, pulmonary function, postoperative opioid use, and other pain-related experiences within 24 h postoperatively. Results: The rates of complete analgesia were not significantly different (23.3% [7/30] and 33.3% [10/30] in the CCB20 and CCB40 groups, respectively; risk difference 10%, 95% CI [–13, 32], P = 0.567). There were no significant differences in other pain-related outcomes. Among the clinical factors considered, the only factor significantly associated with postoperative pain was the sonographic observation of supraclavicular spreading. There were no significant differences in the incidence of HDP and the change in pulmonary function between the two groups.Conclusions: Using 40 ml of local anesthetic does not guarantee supraclavicular spread during CCB. Moreover, it does not result in a higher rate of complete analgesia compared to using 20 ml of local anesthetic in arthroscopic shoulder surgery.

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Section: Incomplete Analgesiamentioning

confidence: 80%

Effect of local anesthetic volume (20 vs. 40 ml) on the analgesic efficacy of costoclavicular block in arthroscopic shoulder surgery: a randomized controlled trial

Jo,

Oh,

Lee

et al. 2024

Korean J Anesthesiol

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“…This BCD approach avoids the drawback of estimating ED 95 using unproven ED 50 ( Pace and Stylianou, 2007 ; Tang et al, 2020 ; Zhu et al, 2020 ; Ni et al, 2022 ) because the peak dose distribution of ED 50 is similar to the average. Therefore, the BCD method combined with the estimation of isotonic regression is often used in anesthesia studies ( Mittal et al, 2019 ; Kewlani et al, 2021 ; Wu et al, 2021 ).…”

Section: Discussionmentioning

confidence: 99%

Determination of the 95% effective dose of remimazolam tosylate in anesthesia induction inhibits endotracheal intubation response in senile patients

Liu

Ouyang

et al. 2023

Front. Pharmacol.

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Background and Purpose: The prevalence of elderly patients prompts anesthesiologists to determine the optimal dose of medication due to the altered pharmacokinetics and pharmacodynamics of this population. The present study aimed to determine the 95% effective dose (ED95) of remimazolam tosylate in anesthesia induction to inhibit endotracheal intubation-related cardiovascular reaction in frail and non-frail senile patients.Methods: A prospective sequential allocation dose-finding study of remimazolam tosylate was conducted on 80 elderly patients who received general anesthesia between May and June 2022 at the First Affiliated Hospital of Nanchang University. The initial dose was 0.3 mg/kg. The blood pressure and heart rate fluctuations during intubation were either <20% (negative cardiovascular response) or ≥20% (positive cardiovascular response). If positive, the dose of the next patient was increased by 0.02 mg/kg, while if negative, it was reduced by 0.02 mg/kg according to the 95:5 biased coin design (BCD). The ED95 and 95% confidence intervals (CIs) were determined using R-Foundation isotonic regression and bootstrapping methods.Results: The ED95 of remimazolam tosylate to inhibit the response during tracheal intubation was 0.297 mg/kg (95% CI: 0.231–0.451 mg/kg) and 0.331 mg/kg (95% CI: 0.272–0.472 mg/kg) in frail and non-frail senile patients, respectively.Conculation and Implications: The CI of the two groups overlap, and no difference was detected in the ED95 of remimazolam tosylate in inhibiting endotracheal intubation-related cardiovascular response in frail and non-frail senile patients. These results suggested that remimazolam tosylate is an optimal anesthesia inducer for all elderly patients.Clinical Trial Registration:https://www.chictr.org.cn, identifier ChiCTR2200055709.

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“…The formula, n=2(SD/SEM),2 by Dixon and Massey for binary response variables was used to calculate the sample size 15. Assuming a 1 mg SD and a 0.25 mg SEM, 32 patients were needed.…”

Section: Methodsmentioning

confidence: 99%

Median effective dose of ropivacaine for prophylactic cervical cerclage in Chinese women: a dose-finding study

Liu

Zhao

Ding

et al. 2022

Reg Anesth Pain Med

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BackgroundAlthough intrathecal ropivacaine has been widely used for caesarean delivery, there are limited data for the use of ropivacaine for prophylactic cervical cerclage. We sought to determine the median effective dose of intrathecal ropivacaine for prophylactic cervical cerclage in 50% of patients (ED50) and the calculated dose required for successful block in 95% of patients (ED95).MethodsWe included Chinese women scheduled for prophylactic cervical cerclage under combined spinal-epidural (CSE) anaesthesia in the first or second trimester. A predetermined dose of intrathecal isobaric ropivacaine was administered. If this determined dose achieved an effective block at a level not lower than T12, the next dose was decreased by 0.5 mg. Otherwise, the next dose was increased by 0.5 mg. The primary outcome was the ED50 of intrathecal ropivacaine. Secondary outcomes included the calculated ED95, time from CSE to the start of surgery and so on.ResultsForty patients were included in the study, 23 (57.5%) of 40 received an effective block only with intrathecal ropivacaine, while 17 (42.5%) patients needed extra epidural lidocaine to achieve a successful block. The ED50 of intrathecal ropivacaine confirmed by isotonic regression was 6.9 mg (95% CI, 6.68 to 7.12 mg), and the calculated ED95 was 7.8 mg (95% CI, 7.69 to 10.05 mg). When an effective block was achieved with intrathecal ropivacaine alone, the time to resolution of the sensory and motor blocks was 90 (75–100) min and 90 (60–100) min, respectively.ConclusionsThe ED50 of intrathecal ropivacaine for prophylactic cervical cerclage was 6.9 mg. Intrathecal ropivacaine (7.8 mg) is likely to produce successful anaesthesia in 95% of patients undergoing prophylactic cervical cerclage.Trial registration numberChiCTR2100051418.

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Median Effective Volume of 0.5% Ropivacaine for Ultrasound-guided Costoclavicular Block

Cited by 11 publications

References 22 publications

Effect of local anesthetic volume (20 vs. 40 ml) on the analgesic efficacy of costoclavicular block in arthroscopic shoulder surgery: a randomized controlled trial

Effect of local anesthetic volume (20 vs. 40 ml) on the analgesic efficacy of costoclavicular block in arthroscopic shoulder surgery: a randomized controlled trial

Determination of the 95% effective dose of remimazolam tosylate in anesthesia induction inhibits endotracheal intubation response in senile patients

Median effective dose of ropivacaine for prophylactic cervical cerclage in Chinese women: a dose-finding study

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