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Minimum effective volume of 0.5% ropivacaine for ultrasound-guided costoclavicular brachial plexus block: A dose finding study.
Eur J Anaesthesiol. 2020 Sep; 37(9):780-786.EJ

Abstract

BACKGROUND

Costoclavicular brachial plexus block (CC-BPB) is a relatively new regional anaesthetic technique and there are no data on the minimum effective volume 90 (MEV90) of 0.5% ropivacaine required for an ultrasound-guided CC-BPB.

OBJECTIVE

To determine the MEV90 of 0.5% ropivacaine required to produce surgical anaesthesia with an ultrasound-guided CC-BPB.

DESIGN

Prospective up-down sequential allocation study design.

SETTING

University teaching hospital in Hong Kong from March 2016 to December 2017.

PATIENTS

Forty-eight, ASA physical status I to III patients, aged 70 years or less and scheduled for elective forearm or hand surgery under an ultrasound-guided CC-BPB, were recruited.

INTERVENTION

Ultrasound-guided CC-BPB was performed with the assigned volume of 0.5% ropivacaine. The Dixon 'up-and-down' sequential allocation method using the biased coin design was used to determine the MEV90 of 0.5% ropivacaine. The assigned volume of ropivacaine was based on the outcome of the previous patient. After a block failure the next patient received a volume increase of 2 ml. If the block was a success, the next patient was allocated, with a probability of b = 0.11, to receive 2 ml less, or, with a probability of 1 - b = 0.89, the same volume.

MAIN OUTCOME MEASURES

A successful block was defined as a minimum score of 14 of 16 points, using a composite sensory and motor block score at 45 min after the injection. The study was stopped when 45 successful blocks were achieved. MEV90 with 95% confidence interval was calculated using the centred isotonic regression for point and interval dose response studies.

RESULTS

The MEV90 of 0.5% ropivacaine for ultrasound-guided CC-BPB was 20.9 (95% confidence interval, 20.7 to 21.8) ml. The mean ± SD time to readiness for surgery was 31.4 ± 12.60 min.

CONCLUSION

The MEV90 of 0.5% ropivacaine required to produce surgical anaesthesia with an ultrasound-guided CC-BPB is 20.9 ml.

CLINICAL TRIAL REGISTRATION

The trial was registered with the Chinese Clinical Trials Registry (www.chictr.org.cn, ChiCTR-IOR-15007515, principal investigator: Manoj Kumar Karmakar, date of registration: 4 December 2015).

CLINICAL TRIAL NUMBER AND REGISTRY URL

ChiCTR-IOR-15007515, Chinese Clinical Trials Registry (www.chictr.org.cn).

Authors+Show Affiliations

From the Department of Anaesthesia & Intensive Care, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong, China (MHW, MKK, LYHM, BS, WS).No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

32740321

Citation

Wong, Ming H., et al. "Minimum Effective Volume of 0.5% Ropivacaine for Ultrasound-guided Costoclavicular Brachial Plexus Block: a Dose Finding Study." European Journal of Anaesthesiology, vol. 37, no. 9, 2020, pp. 780-786.
Wong MH, Karmakar MK, Mok LYH, et al. Minimum effective volume of 0.5% ropivacaine for ultrasound-guided costoclavicular brachial plexus block: A dose finding study. Eur J Anaesthesiol. 2020;37(9):780-786.
Wong, M. H., Karmakar, M. K., Mok, L. Y. H., Songthamwat, B., & Samy, W. (2020). Minimum effective volume of 0.5% ropivacaine for ultrasound-guided costoclavicular brachial plexus block: A dose finding study. European Journal of Anaesthesiology, 37(9), 780-786. https://doi.org/10.1097/EJA.0000000000001287
Wong MH, et al. Minimum Effective Volume of 0.5% Ropivacaine for Ultrasound-guided Costoclavicular Brachial Plexus Block: a Dose Finding Study. Eur J Anaesthesiol. 2020;37(9):780-786. PubMed PMID: 32740321.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Minimum effective volume of 0.5% ropivacaine for ultrasound-guided costoclavicular brachial plexus block: A dose finding study. AU - Wong,Ming H, AU - Karmakar,Manoj K, AU - Mok,Louis Y H, AU - Songthamwat,Banchobporn, AU - Samy,Winnie, PY - 2020/8/3/pubmed PY - 2021/4/28/medline PY - 2020/8/3/entrez SP - 780 EP - 786 JF - European journal of anaesthesiology JO - Eur J Anaesthesiol VL - 37 IS - 9 N2 - BACKGROUND: Costoclavicular brachial plexus block (CC-BPB) is a relatively new regional anaesthetic technique and there are no data on the minimum effective volume 90 (MEV90) of 0.5% ropivacaine required for an ultrasound-guided CC-BPB. OBJECTIVE: To determine the MEV90 of 0.5% ropivacaine required to produce surgical anaesthesia with an ultrasound-guided CC-BPB. DESIGN: Prospective up-down sequential allocation study design. SETTING: University teaching hospital in Hong Kong from March 2016 to December 2017. PATIENTS: Forty-eight, ASA physical status I to III patients, aged 70 years or less and scheduled for elective forearm or hand surgery under an ultrasound-guided CC-BPB, were recruited. INTERVENTION: Ultrasound-guided CC-BPB was performed with the assigned volume of 0.5% ropivacaine. The Dixon 'up-and-down' sequential allocation method using the biased coin design was used to determine the MEV90 of 0.5% ropivacaine. The assigned volume of ropivacaine was based on the outcome of the previous patient. After a block failure the next patient received a volume increase of 2 ml. If the block was a success, the next patient was allocated, with a probability of b = 0.11, to receive 2 ml less, or, with a probability of 1 - b = 0.89, the same volume. MAIN OUTCOME MEASURES: A successful block was defined as a minimum score of 14 of 16 points, using a composite sensory and motor block score at 45 min after the injection. The study was stopped when 45 successful blocks were achieved. MEV90 with 95% confidence interval was calculated using the centred isotonic regression for point and interval dose response studies. RESULTS: The MEV90 of 0.5% ropivacaine for ultrasound-guided CC-BPB was 20.9 (95% confidence interval, 20.7 to 21.8) ml. The mean ± SD time to readiness for surgery was 31.4 ± 12.60 min. CONCLUSION: The MEV90 of 0.5% ropivacaine required to produce surgical anaesthesia with an ultrasound-guided CC-BPB is 20.9 ml. CLINICAL TRIAL REGISTRATION: The trial was registered with the Chinese Clinical Trials Registry (www.chictr.org.cn, ChiCTR-IOR-15007515, principal investigator: Manoj Kumar Karmakar, date of registration: 4 December 2015). CLINICAL TRIAL NUMBER AND REGISTRY URL: ChiCTR-IOR-15007515, Chinese Clinical Trials Registry (www.chictr.org.cn). SN - 1365-2346 UR - https://www.unboundmedicine.com/medline/citation/32740321/Minimum_effective_volume_of_0_5_ropivacaine_for_ultrasound_guided_costoclavicular_brachial_plexus_block:_A_dose_finding_study_ L2 - https://doi.org/10.1097/EJA.0000000000001287 DB - PRIME DP - Unbound Medicine ER -