Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1016/j.bjane.2023.08.005
Brazilian Journal of Anesthesiology
Original Investigation

Minimum effective concentration of ropivacaine for ultrasound-guided transmuscular quadratus lumborum block in total hip arthroplasty: a randomized clinical trial

Concentração mínima efetiva de ropivacaína para bloqueio transmuscular do quadrado lombar guiado por ultrassom em artroplastia total de quadril: ensaio clínico randomizado

Jian Hu, Xingcheng Li, Qiuru Wang, Jing Yang

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Abstract

Objective

This trial aimed to identify the Minimum Effective Concentration (MEC90, defined as the concentration which can provide successful block in 90% of patients) of 30 mL ropivacaine for single-shot ultrasound-guided transmuscular Quadratus Lumborum Block (QLB) in patients undergoing Total Hip Arthroplasty (THA).

Methods

A double-blind, randomized dose-finding study using the biased coin design up-and-down sequential method, where the concentration of local anesthetic administered to each patient depended on the response from the previous one. Block success was defined as a Numeric Rating Scale (NRS) score during motion ≤ 3 at 6 hours after arrival in the ward. If the block was successful, the next subject received either a 0.025% smaller dose (probability of 0.11) or the same dose (probability of 0.89); otherwise, the next subject received a 0.025% higher ropivacaine concentration. MEC90, MEC95 and MEC99 were estimated by isotonic regression, and the corresponding 95% Confidence Intervals (95% CIs) were calculated by the bootstrapping method.

Results

Based on the analysis of 52 patients, MEC90, MEC95, and MEC99 of ropivacaine for QLB were estimated to be 0.352% (95% CI 0.334–0.372%), 0.363% (95% CI 0.351–0.383%), and 0.373% (95% CI 0.363–0.386%). The concentration of ropivacaine at 0.352% in a volume of 30 ml can provide a successful block in 90% of patients.

Conclusions

For ultrasound-guided transmuscular QLB in patients undergoing THA, 0.352% ropivacaine in a volume of 30 ml can provide a successful block in 90% of patients. Further dose-finding studies and large sample size are required to verify the concentration.

Keywords

Analgesia Ropivacaine Nerve block Drug dose-response relationship Total hip arthroplasty

Resumo

Introdução

Este estudo teve como objetivo identificar a concentração mínima eficaz (MEC90, definida como a concentração que pode fornecer bloqueio bem-sucedido em 90% dos pacientes) de 30 mL de ropivacaína para bloqueio transmuscular do quadrado lombar (BQL) guiado por ultrassom de dose única em pacientes submetidos a cirurgia de artroplastia total de quadril (ATQ).

Métodos

Estudo duplo-cego, randomizado de determinação de dose usando o método sequencial up-and-down de desenho de moeda tendenciosa, onde a concentração de anestésico local administrado a cada paciente dependia da resposta do anterior. O sucesso do bloqueio foi definido como uma pontuação na Escala de Avaliação Numérica (NRS) durante o movimento ≤ 3, 6 horas após a chegada à enfermaria. Se o bloqueio fosse bem-sucedido, o próximo sujeito recebia uma dose 0,025% menor (probabilidade de 0,11) ou a mesma dose (probabilidade de 0,89); caso contrário, o próximo sujeito recebeu uma concentração de ropivacaína 0,025% maior. MEC90, MEC95 e MEC99 foram estimados por regressão isotônica, e os correspondentes intervalos de confiança de 95% (IC95%) foram calculados pelo método de bootstrapping.

Resultados

Com base na análise de 52 pacientes, MEC90, MEC95 e MEC99 de ropivacaína para BQL foram estimados em 0,352% (IC 95% 0,334–0,372%), 0,363% (IC 95% 0,351–0,383%) e 0,373% ( IC 95% 0,363–0,386%). A concentração de ropivacaína a 0,352% em um volume de 30 ml pode proporcionar bloqueio bem-sucedido em 90% dos pacientes.

Conclusão

Para BQL transmuscular guiado por ultrassom em pacientes submetidos à ATQ, a ropivacaína a 0,352% em um volume de 30 ml pode proporcionar um bloqueio bem-sucedido em 90% dos pacientes. Mais estudos de determinação de dose e um grande tamanho de amostra são necessários para verificar a concentração.

Palavras-chave

Analgesia; Ropivacaína; Bloqueio nervoso; Relação dose-resposta do medicamento; Artroplastia total do quadril

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Submitted date:
12/02/2022

Accepted date:
08/20/2023

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