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Median Effective Volume of 0.5% Ropivacaine for Ultrasound-guided Costoclavicular Block.
Anesthesiology. 2021 04 01; 134(4):617-625.A

Abstract

BACKGROUND

The median effective dose of ropivacaine required for producing an effective costoclavicular block has not yet been determined. The authors conducted this dose-finding study with the objective of determining the median effective dose of 0.5% ropivacaine required to produce a successful costoclavicular block for surgical anesthesia in 50% of the patients (ED50) as well as the calculated dose required for effective blockade in 95% of the patients (ED95).

METHODS

This single-armed prospective study was conducted on 40 American Society of Anesthesiologists physical status I or II patients, aged 18 to 60 yr, with a body mass index of 18 to 30 kg/m2, scheduled to undergo forearm and hand surgeries under ultrasound-guided costoclavicular block. A volume of 0.5% ropivacaine administered in the costoclavicular space was determined using the sample up-and-down sequential allocation study design of binary response variables. The first patient received a volume of 26 ml of 0.5% ropivacaine. After a successful or unsuccessful block, the volume of local anesthetic was decreased or increased, respectively, by 2 ml in the next patient. Evaluation of sensory and motor block was performed every 5 min for 30 min and graded using a 3-point scale. Surgical anesthesia was considered to be successful if a minimum score of 14 was achieved and the surgeon was able to proceed with surgery without needing to supplement anesthesia.

RESULTS

The volume of local anesthetic administered ranged from 8 to 26 ml. Centered isotonic regression with a bias-corrected Morris 95% CI derived by bootstrapping showed ED50 of 13.5 ml (95% CI, 11.5 to 15.4 ml) and ED95 of 18.9 ml (95% CI, 17.9 to 27.5 ml).

CONCLUSIONS

A 19-ml dose of 0.5% ropivacaine is likely to produce an effective ultrasound-guided costoclavicular block for providing adequate surgical anesthesia to 95% of the patients.

EDITOR’S PERSPECTIVE

Authors

No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

33636000

Citation

Kewlani, Anu, et al. "Median Effective Volume of 0.5% Ropivacaine for Ultrasound-guided Costoclavicular Block." Anesthesiology, vol. 134, no. 4, 2021, pp. 617-625.
Kewlani A, Bhatia N, Makkar JK, et al. Median Effective Volume of 0.5% Ropivacaine for Ultrasound-guided Costoclavicular Block. Anesthesiology. 2021;134(4):617-625.
Kewlani, A., Bhatia, N., Makkar, J. K., & Kumar, V. (2021). Median Effective Volume of 0.5% Ropivacaine for Ultrasound-guided Costoclavicular Block. Anesthesiology, 134(4), 617-625. https://doi.org/10.1097/ALN.0000000000003731
Kewlani A, et al. Median Effective Volume of 0.5% Ropivacaine for Ultrasound-guided Costoclavicular Block. Anesthesiology. 2021 04 1;134(4):617-625. PubMed PMID: 33636000.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Median Effective Volume of 0.5% Ropivacaine for Ultrasound-guided Costoclavicular Block. AU - Kewlani,Anu, AU - Bhatia,Nidhi, AU - Makkar,Jeetinder Kaur, AU - Kumar,Vishal, PY - 2021/2/27/pubmed PY - 2021/4/22/medline PY - 2021/2/26/entrez SP - 617 EP - 625 JF - Anesthesiology JO - Anesthesiology VL - 134 IS - 4 N2 - BACKGROUND: The median effective dose of ropivacaine required for producing an effective costoclavicular block has not yet been determined. The authors conducted this dose-finding study with the objective of determining the median effective dose of 0.5% ropivacaine required to produce a successful costoclavicular block for surgical anesthesia in 50% of the patients (ED50) as well as the calculated dose required for effective blockade in 95% of the patients (ED95). METHODS: This single-armed prospective study was conducted on 40 American Society of Anesthesiologists physical status I or II patients, aged 18 to 60 yr, with a body mass index of 18 to 30 kg/m2, scheduled to undergo forearm and hand surgeries under ultrasound-guided costoclavicular block. A volume of 0.5% ropivacaine administered in the costoclavicular space was determined using the sample up-and-down sequential allocation study design of binary response variables. The first patient received a volume of 26 ml of 0.5% ropivacaine. After a successful or unsuccessful block, the volume of local anesthetic was decreased or increased, respectively, by 2 ml in the next patient. Evaluation of sensory and motor block was performed every 5 min for 30 min and graded using a 3-point scale. Surgical anesthesia was considered to be successful if a minimum score of 14 was achieved and the surgeon was able to proceed with surgery without needing to supplement anesthesia. RESULTS: The volume of local anesthetic administered ranged from 8 to 26 ml. Centered isotonic regression with a bias-corrected Morris 95% CI derived by bootstrapping showed ED50 of 13.5 ml (95% CI, 11.5 to 15.4 ml) and ED95 of 18.9 ml (95% CI, 17.9 to 27.5 ml). CONCLUSIONS: A 19-ml dose of 0.5% ropivacaine is likely to produce an effective ultrasound-guided costoclavicular block for providing adequate surgical anesthesia to 95% of the patients. EDITOR’S PERSPECTIVE: SN - 1528-1175 UR - https://www.unboundmedicine.com/medline/citation/33636000/Median_Effective_Volume_of_0_5_Ropivacaine_for_Ultrasound_guided_Costoclavicular_Block_ L2 - https://pubs.asahq.org/anesthesiology/article-lookup/doi/10.1097/ALN.0000000000003731 DB - PRIME DP - Unbound Medicine ER -