Brazilian Journal of Anesthesiology
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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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.


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


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.


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


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