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Effects of age on minimum effective volume of local anesthetic for ultrasound-guided supraclavicular brachial plexus block.
Acta Anaesthesiol Scand. 2013 Jul; 57(6):761-6.AA

Abstract

BACKGROUND

Involutional changes of peripheral nervous system occur with aging. The aim of the study was to determine the minimum effective volume of local anesthetic required to offer an effective ultrasound-guided supraclavicular brachial plexus block in 50% of middle-aged (< 50 years) and elderly (> 65 years) patients. We hypothesized reduced minimum effective volume of local anesthetic in elderly patients.

METHODS

Middle-aged (n = 22) and elderly (n = 22) patients undergoing upper limb surgery received an ultrasound-guided supraclavicular brachial plexus block. Structural analysis of the brachial plexus in supraclavicular region was obtained by measuring the cross-sectional area. The prospective, observer-blinded study method is a previously validated step-up/step-down sequence model where the local anesthetic volume for the next patient is determined by the outcome of the previous block. The starting volume was 30 ml (50 : 50 mixture, 0.5%wt/vol levobupivacaine, 2%wt/vol lidocaine). The minimum effective volume of local anesthetic was determined using Dixon and Masey method.

RESULTS

The minimum effective local anesthetic volume significantly differed between middle-aged and elderly [23.0 ml, 95% confidence interval (CI) 13.7-32.3 vs. 11.9 ml, 95% CI 9.3-14.6; 95% CI of the difference 1.6-20.6, P = 0.027]. The cross-sectional area of brachial plexus was 0.95 ± 0.15 in middle-aged and 0.51 ± 0.06 cm(2) in elderly patients (P < 0.001).

CONCLUSIONS

Within the present study, we report a reduced minimum effective anesthetic volume for ultrasound-guided supraclavicular block in elderly patients. Additionally, smaller cross-sectional surface area of brachial plexus in the supraclavicular region was observed.

Authors+Show Affiliations

Department of Anesthesiology and Intensive Care, University Hospital Merkur, Zagreb, Croatia. jadranka.pavicic-saric@st.t-com.hrNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Clinical Trial
Comparative Study
Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

23527790

Citation

Pavičić Šarić, Jadranka, et al. "Effects of Age On Minimum Effective Volume of Local Anesthetic for Ultrasound-guided Supraclavicular Brachial Plexus Block." Acta Anaesthesiologica Scandinavica, vol. 57, no. 6, 2013, pp. 761-6.
Pavičić Šarić J, Vidjak V, Tomulić K, et al. Effects of age on minimum effective volume of local anesthetic for ultrasound-guided supraclavicular brachial plexus block. Acta Anaesthesiol Scand. 2013;57(6):761-6.
Pavičić Šarić, J., Vidjak, V., Tomulić, K., & Zenko, J. (2013). Effects of age on minimum effective volume of local anesthetic for ultrasound-guided supraclavicular brachial plexus block. Acta Anaesthesiologica Scandinavica, 57(6), 761-6. https://doi.org/10.1111/aas.12109
Pavičić Šarić J, et al. Effects of Age On Minimum Effective Volume of Local Anesthetic for Ultrasound-guided Supraclavicular Brachial Plexus Block. Acta Anaesthesiol Scand. 2013;57(6):761-6. PubMed PMID: 23527790.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Effects of age on minimum effective volume of local anesthetic for ultrasound-guided supraclavicular brachial plexus block. AU - Pavičić Šarić,Jadranka, AU - Vidjak,Vinko, AU - Tomulić,Katarina, AU - Zenko,Jelena, Y1 - 2013/03/25/ PY - 2013/02/15/accepted PY - 2013/3/27/entrez PY - 2013/3/27/pubmed PY - 2013/10/25/medline SP - 761 EP - 6 JF - Acta anaesthesiologica Scandinavica JO - Acta Anaesthesiol Scand VL - 57 IS - 6 N2 - BACKGROUND: Involutional changes of peripheral nervous system occur with aging. The aim of the study was to determine the minimum effective volume of local anesthetic required to offer an effective ultrasound-guided supraclavicular brachial plexus block in 50% of middle-aged (< 50 years) and elderly (> 65 years) patients. We hypothesized reduced minimum effective volume of local anesthetic in elderly patients. METHODS: Middle-aged (n = 22) and elderly (n = 22) patients undergoing upper limb surgery received an ultrasound-guided supraclavicular brachial plexus block. Structural analysis of the brachial plexus in supraclavicular region was obtained by measuring the cross-sectional area. The prospective, observer-blinded study method is a previously validated step-up/step-down sequence model where the local anesthetic volume for the next patient is determined by the outcome of the previous block. The starting volume was 30 ml (50 : 50 mixture, 0.5%wt/vol levobupivacaine, 2%wt/vol lidocaine). The minimum effective volume of local anesthetic was determined using Dixon and Masey method. RESULTS: The minimum effective local anesthetic volume significantly differed between middle-aged and elderly [23.0 ml, 95% confidence interval (CI) 13.7-32.3 vs. 11.9 ml, 95% CI 9.3-14.6; 95% CI of the difference 1.6-20.6, P = 0.027]. The cross-sectional area of brachial plexus was 0.95 ± 0.15 in middle-aged and 0.51 ± 0.06 cm(2) in elderly patients (P < 0.001). CONCLUSIONS: Within the present study, we report a reduced minimum effective anesthetic volume for ultrasound-guided supraclavicular block in elderly patients. Additionally, smaller cross-sectional surface area of brachial plexus in the supraclavicular region was observed. SN - 1399-6576 UR - https://www.unboundmedicine.com/medline/citation/23527790/Effects_of_age_on_minimum_effective_volume_of_local_anesthetic_for_ultrasound_guided_supraclavicular_brachial_plexus_block_ L2 - https://doi.org/10.1111/aas.12109 DB - PRIME DP - Unbound Medicine ER -