Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1016/j.bjane.2021.12.008
Brazilian Journal of Anesthesiology
Original Investigation

Determination of the minimum effective volume of bupivacaine for ultrasound-guided infraclavicular brachial plexus block: a prospective, observer-blind, controlled study

Determinação do volume mínimo efetivo de bupivacaína para bloqueio do plexo braquial infraclavicular guiado por ultrassom: estudo prospectivo, observador-cego e controlado

Semih Başkan, Çağıl Vural, Necati Alper Erdoğmuş, İsmail Aytaç

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Abstract

Background: We aimed to determine the minimum effective volume (MEV) of 0.5% bupivacaine for infraclavicular brachial plexus block. 
Methods: We assigned patients to volume groups consisting of five consecutive patients. Local anesthetic was sequentially reduced from a starting dose of 30 mL by 2 mL to form the volume groups. Five patients were included in each volume group, and at least 3 of 5 injections had to be successful to consider the volume of the anesthetic as sufficient. The study ended when the anesthetic volume of a group was determined to be unsuccessful (two or fewer successful blocks). Block was successful if the patient reported a sensorial block score of 7 or more on an 8-point scale and sensorial and motor block’s total score of 14 on a 16-point scale.
Results: The MEV of 0.5% bupivacaine for infraclavicular brachial plexus block was 14 mL. A successful block was achieved in all patients (n = 45) in 9 volume groups, which received 30 mL down to 14 mL. Three blocks were unsuccessful in the 12-mL group. Time to onset of block and time to first postoperative anesthetic administration was 15 (10−15) min and more than 24 h in the 30-mL bupivacaine group, but 40 (30−45) min and 14 (10−24) h were determined for the 14-mL group, respectively.
Conclusions: The MEV of 0.5% bupivacaine for ultrasound-guided infraclavicular brachial plexus block was 14 mL. However, this low-dose block has a long onset time of 40 (30−45) min on average.

Keywords

Brachial plexus block; Bupivacaine; Drug dose-response relationship; Regional anesthesia

Resumo

Justificativa: Nosso objetivo foi determinar o volume efetivo mínimo (VEM) de bupivacaína a 0,5% para bloqueio do plexo braquial infraclavicular. Métodos: Os pacientes foram alocados em grupos de volume consistindo em cinco pacientes consecutivos. O anestésico local foi reduzido sequencialmente de uma dose inicial de 30 mL por 2 mL para formar os grupos de volume. Cinco pacientes foram incluídos em cada grupo de volume, e pelo menos 3 de 5 injeções tiveram que ser bem-sucedidas para considerar o volume do anestésico como suficiente. O estudo terminou quando o volume anestésico de um grupo foi determinado como infrutífero (dois ou menos bloqueios bem-sucedidos). O bloqueio foi bem-sucedido se o paciente relatasse uma pontuação de bloqueio sensorial de 7 ou mais em uma escala de 8 pontos e uma pontuação total de bloqueio sensorial e motor de 14 em uma escala de 16 pontos. Resultados: O VEM de bupivacaína a 0,5% para bloqueio do plexo braquial infraclavicular foi de 14 mL. Um bloqueio bem-sucedido foi alcançado em todos os pacientes (n = 45) em 9 grupos de volume, que receberam 30 mL até 14 mL. Três bloqueios não obtiveram sucesso no grupo de 12 mL. O tempo para início do bloqueio e o tempo para a primeira administração de anestésico pós-operatório foi de 15 (10−15) min e mais de 24 h no grupo de 30 mL de bupivacaína, mas 40 (30−45) min e 14 (10−24) h foram determinado para o grupo de 14 mL, respectivamente. Conclusões: O VEM de bupivacaína a 0,5% para bloqueio do plexo braquial infraclavicular guiado por ultrassom foi de 14 mL. No entanto, este bloqueio de baixa dose tem um longo tempo de início de 40 (30-45) min em média.

Palavras-chave

Bloqueio do plexo braquial; Bupivacaína; Relação dose-resposta do medicamento; Anestesia regional

References

1 KK Gupta, JP Attri, A. Singh Ultrasound guided brachial plexus block Anaesth Pain & Intensive Care, 20 (2016), pp. 187-192

2 BD Sites, AH Taenzer, MD Herrick, et al. Incidence of local anesthetic systemic toxicity and postoperative neurologic symptoms associated with 12,668 ultrasound-guided nerve blocks: an analysis from a prospective clinical registry Reg Anesth Pain Med, 37 (2012), pp. 478-482

3 EE Morwald, N Zubizarreta, C Cozowicz, et al. Incidence of local anesthetic systemic toxicity in orthopedic patients receiving peripheral nerve blocks Reg Anesth Pain Med, 42 (2017), pp. 442-445

4 S. Başkan Bilateral infraclavicular block administration in a case of co-existing rheumatoid arthritis and pemphigus vulgaris Ann Clin Anal Med, 11 (Suppl 2) (2020), pp. 138-140

5 P Cuvillon, E Nouvellon, J Ripart, et al. A comparison of the pharmacodynamics and pharmacokinetics of bupivacaine, ropivacaine (with epinephrine) and their equal volume mixtures with lidocaine used for femoral and sciatic nerve blocks: an observer-blind randomized study Anesth Analg, 108 (2009), pp. 641-649

6 AS Kavaklı, NK Ozturk, U. Arslan Minimum effective volume of bupivacaine 0.5% for ultrasound-guided retroclavicular approach to infraclavicular brachial plexus block Braz J Anesth, 69 (2019), pp. 253-258 3

7 DQ Tran, S Dugani, A Dyachenko, et al. Minimum effective volume of lidocaine for ultrasound-guided infraclavicular block Reg Anesth Pain Med, 36 (2011), pp. 190-194

8 O Klaastad, HJ Smith, O Smedby, et al. A novel infraclavicular brachial plexus block: the lateral and sagittal technique, developed by magnetic resonance imaging studies Anesth Analg, 98 (2004), pp. 252-256

9 E Albrecht, J Mermoud, N Fournier, et al. A systematic review of ultrasound-guided methods for brachial plexus blockade Anaesth, 71 (2016), pp. 213-227

10 SD Petrar, ME Seltenrich, SJ Head, et al. Hemidiaphragmatic paralysis following ultrasound-guided supraclavicular versus infraclavicular brachial plexus blockade: a randomized clinical trial regional Anesth Pain Med, 40 (2015), pp. 133-138

11 T Walid, BA Mondher, L Mohamed Anis, et al. A case of Horner's syndrome following ultrasound-guided infraclavicular brachial plexus block Case Rep Anesthesiol (2012), Article 125346

12 DG Brenner, Z Marjanek, G. Iohom Estimation of the minimum effective volume of 0.5% bupivacaine for ultrasound-guided axillary brachial plexus block Euro J Anaesthesiol, 33 (2016), pp. 463-464

13 JRP Pedro, LAST Mathias, JL Gozzani, et al. Supraclavicular brachial plexus block: a comparative clinical study between bupivacaine and levobupivacaine Braz J Anesthesiol, 59 (2009), pp. 665-673

14 SK Park, SY Lee, WH Kim, et al. Comparison of supraclavicular and infraclavicular brachial plexus block: a systemic review of randomized controlled trials Anesth Analg, 124 (2017), pp. 636-644

15 DE Becker, KL. Reed Essentials of local anesthetic pharmacology Anesth Prog, 53 (2006), pp. 98-108 quiz 109-10

16 A Kumari, A Rajput, L Mahajan, et al. A study to evaluate the effectiveness of bupivacaine (0.5%) versus ropivacaine (0.5%, 0.75%) in patients undergoing upper limb surgery under brachial plexus block India J Clin Anaesth, 4 (2017), pp. 153-159

17 O Pongraweewan, N Inchua, C Kitsiripant, et al. Onset time of 2% lidocaine and 0.5% bupivacaine mixture versus 0.5% bupivacaine alone using ultrasound and double nerve stimulation for infraclavicular brachial plexus anesthesia in esrd patients undergoing arteriovenous fistula creation J Med Assoc Thai, 99 (2016), pp. 589-595

18 JJ Laur, EO Bayman, PJ Foldes, et al. Triple-blind randomized clinical trial of time until sensory change using 1.5% mepivacaine with epinephrine, 0.5% bupivacaine, or an equal mixture of both for infraclavicular block Reg Anesth Pain Med, 37 (2012), pp. 28-33

19 O Liisanantti, J Luukkonen, P. Rosenberg High-dose bupivacaine, levobupivacaine and ropivacaine in axillary brachial plexus block Acta Anaesthesiologica Scandinavica, 48 (2004), pp. 601-606

20 Ö Özmen, HA Alici, M Çelik, et al. The effect of addition of lidocaine to bupivacaine on anesthesia beginning time, block time, and block quality in lateral sagittal infraclavicular block Turk J Med Sci, 43 (2013), pp. 542-547

21 C Jandard, ME Gentili, F Girard, et al. Infraclavicular block with lateral approach and nerve stimulation: extent of anesthesia and adverse effects Reg Anesth Pain Med, 27 (2002), pp. 37-42

22 V Trehan, U Srivastava, A Kumar, et al. Comparison of two approaches of infraclavicular brachial plexus block for orthopedic surgery below midhumerus India J Anaesth, 54 (2010), pp. 210-214

23 A Stav, L Reytman, MY Stav, et al. Comparison of the supraclavicular, infraclavicular and axillary approaches for ultrasound-guided brachial plexus block for surgical anesthesia Rambam Maimonides Med J, 7 (2016), p. e0013

24 N Bharti, N Bhardawaj, J. Wig Comparison of ultrasound-guided supraclavicular, infraclavicular and below-C6 interscalene brachial plexus block for upper limb surgery: a randomized, observer-blinded study Anaesth Intensive Care, 43 (2015), pp. 468-472

25 A Di Filippo, S Falsini, C Adembri Minimum anesthetic volume in regional anesthesia by using ultrasound-guidance Braz J Anesthesiol, 66 (2016), pp. 499-504


Submitted date:
01/30/2020

Accepted date:
12/19/2021

62158476a953953c1e4bde84 rba Articles
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