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Minimum Effective Volume of Lidocaine for Ultrasound-Guided Costoclavicular Block.
Reg Anesth Pain Med. 2017 Sep/Oct; 42(5):571-574.RA

Abstract

BACKGROUND AND OBJECTIVES

This dose-finding study aimed to determine the minimum effective volume in 90% of patients (MEV90) of lidocaine 1.5% with epinephrine 5 μg/mL for ultrasound-guided costoclavicular block.

METHODS

Using an in-plane technique and a lateral-to-medial direction, the block needle was positioned in the middle of the 3 cords of the brachial plexus in the costoclavicular space. The entire volume of lidocaine was deposited in this location. Dose assignment was carried out using a biased-coin-design up-and-down sequential method, where the total volume of local anesthetic administered to each patient depended on the response of the previous one. In case of failure, the next subject received a higher volume (defined as the previous volume with an increment of 2.5 mL). If the previous patient had a successful block, the next subject was randomized to a lower volume (defined as the previous volume with a decrement of 2.5 mL), with a probability of b = 0.11, or the same volume, with a probability of 1 - b = 0.89. Success was defined, at 30 minutes, as a minimal score of 14 of 16 points using a sensorimotor composite scale. Patients undergoing surgery of the elbow, forearm, wrist, or hand were prospectively enrolled until 45 successful blocks were obtained. This clinical trial was registered with ClinicalTrials.gov (ID NCT02932670).

RESULTS

Fifty-seven patients were included in the study. Using isotonic regression and bootstrap confidence interval, the MEV90 for ultrasound-guided costoclavicular block was estimated to be 34.0 mL (95% confidence interval, 33.4-34.4 mL). All patients with a minimal composite score of 14 points at 30 minutes achieved surgical anesthesia intraoperatively.

CONCLUSIONS

For ultrasound-guided costoclavicular block, the MEV90 of lidocaine 1.5% with epinephrine 5 μg/mL is 34 mL. Further dose-finding studies are required for other concentrations of lidocaine, other local anesthetic agents, and multiple-injection techniques.

Authors+Show Affiliations

From the *Montreal General Hospital, Department of Anesthesia, McGill University, Montreal, Quebec, Canada; †Department of Anesthesia, Pontificia Universidad Católica de Chile, Santiago, Chile; and ‡Maharaj Nakorn Chiang Mai Hospital, Department of Anesthesia, Chiang Mai University, Chiang Mai, Thailand.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Multicenter Study
Randomized Controlled Trial

Language

eng

PubMed ID

28723837

Citation

Sotthisopha, Thitipan, et al. "Minimum Effective Volume of Lidocaine for Ultrasound-Guided Costoclavicular Block." Regional Anesthesia and Pain Medicine, vol. 42, no. 5, 2017, pp. 571-574.
Sotthisopha T, Elgueta MF, Samerchua A, et al. Minimum Effective Volume of Lidocaine for Ultrasound-Guided Costoclavicular Block. Reg Anesth Pain Med. 2017;42(5):571-574.
Sotthisopha, T., Elgueta, M. F., Samerchua, A., Leurcharusmee, P., Tiyaprasertkul, W., Gordon, A., Finlayson, R. J., & Tran, D. Q. (2017). Minimum Effective Volume of Lidocaine for Ultrasound-Guided Costoclavicular Block. Regional Anesthesia and Pain Medicine, 42(5), 571-574. https://doi.org/10.1097/AAP.0000000000000629
Sotthisopha T, et al. Minimum Effective Volume of Lidocaine for Ultrasound-Guided Costoclavicular Block. Reg Anesth Pain Med. 2017 Sep/Oct;42(5):571-574. PubMed PMID: 28723837.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Minimum Effective Volume of Lidocaine for Ultrasound-Guided Costoclavicular Block. AU - Sotthisopha,Thitipan, AU - Elgueta,Maria Francisca, AU - Samerchua,Artid, AU - Leurcharusmee,Prangmalee, AU - Tiyaprasertkul,Worakamol, AU - Gordon,Aida, AU - Finlayson,Roderick J, AU - Tran,De Q, PY - 2017/7/21/pubmed PY - 2018/9/18/medline PY - 2017/7/21/entrez SP - 571 EP - 574 JF - Regional anesthesia and pain medicine JO - Reg Anesth Pain Med VL - 42 IS - 5 N2 - BACKGROUND AND OBJECTIVES: This dose-finding study aimed to determine the minimum effective volume in 90% of patients (MEV90) of lidocaine 1.5% with epinephrine 5 μg/mL for ultrasound-guided costoclavicular block. METHODS: Using an in-plane technique and a lateral-to-medial direction, the block needle was positioned in the middle of the 3 cords of the brachial plexus in the costoclavicular space. The entire volume of lidocaine was deposited in this location. Dose assignment was carried out using a biased-coin-design up-and-down sequential method, where the total volume of local anesthetic administered to each patient depended on the response of the previous one. In case of failure, the next subject received a higher volume (defined as the previous volume with an increment of 2.5 mL). If the previous patient had a successful block, the next subject was randomized to a lower volume (defined as the previous volume with a decrement of 2.5 mL), with a probability of b = 0.11, or the same volume, with a probability of 1 - b = 0.89. Success was defined, at 30 minutes, as a minimal score of 14 of 16 points using a sensorimotor composite scale. Patients undergoing surgery of the elbow, forearm, wrist, or hand were prospectively enrolled until 45 successful blocks were obtained. This clinical trial was registered with ClinicalTrials.gov (ID NCT02932670). RESULTS: Fifty-seven patients were included in the study. Using isotonic regression and bootstrap confidence interval, the MEV90 for ultrasound-guided costoclavicular block was estimated to be 34.0 mL (95% confidence interval, 33.4-34.4 mL). All patients with a minimal composite score of 14 points at 30 minutes achieved surgical anesthesia intraoperatively. CONCLUSIONS: For ultrasound-guided costoclavicular block, the MEV90 of lidocaine 1.5% with epinephrine 5 μg/mL is 34 mL. Further dose-finding studies are required for other concentrations of lidocaine, other local anesthetic agents, and multiple-injection techniques. SN - 1532-8651 UR - https://www.unboundmedicine.com/medline/citation/28723837/Minimum_Effective_Volume_of_Lidocaine_for_Ultrasound_Guided_Costoclavicular_Block_ L2 - https://rapm.bmj.com/lookup/pmidlookup?view=long&pmid=28723837 DB - PRIME DP - Unbound Medicine ER -