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).
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 -
