Minimum effective volume of bupivacaine 0. 5% for ultrasound-guided retroclavicular approach to infraclavicular brachial plexus block / Volume mínimo efetivo de bupivacaína a 0, 5% para abordagem retroclavicular guiada por ultrassom no bloqueio do plexo braquial por via infraclavicular

Abstract Background and objectives: The current study aimed to determine the minimum effective volume (MEV) of bupivacaine 0.5% in 50% of patients for an ultrasound-guided retroclavicular approach to infraclavicular brachial plexus block. Methods: A total of 25 adult patients who were scheduled for upper limb surgery received an ultrasound-guided retroclavicular approach to infraclavicular brachial plexus block with bupivacaine 0.5%. The needle insertion point was posterior to the clavicle and the needle was advanced from cephalad to caudal. Block success was defined as a composite score of 14 at 30 min after local anesthetic (LA) injection. The minimum effective volume in 50% of patients was determined using the Dixon-Massey up-and-down staircase method. Minimum effective volume for a successful block in 95% of the patients was also calculated using logistic regression and probit transformation. Results: The minimum effective volume of bupivacaine 0.5% resulting in successful block in 50% of patients (MEV50) according to the up-and-down staircase method was found to be 9.6 mL (95% confidence interval (CI), 5.7-13.4). The calculated minimum effective volume required for a successful block in 95% of patients (MEV95) using the probit transformation and logistic regression analysis was 23.2 mL (95% CI, 18.8-36.7). Conclusions: The MEV50 of bupivacaine 0.5% for US-guided retroclavicular approach to infraclavicular brachial plexus block was 9.6 mL and the calculated MEV95 was 23.2 mL. Future studies are required for infraclavicular brachial plexus block with different approaches, other LA agents and different concentrations of bupivacaine.

Resumo Justificativa e objetivos: Determinar o volume mínimo efetivo (VE) de bupivacaína a 0,5% em 50% dos pacientes para uma abordagem retroclavicular guiada por ultrassom no bloqueio do plexo braquial por via infraclavicular. Métodos: Um total de 25 pacientes adultos agendados para cirurgia do membro superior receberam abordagem retroclavicular guiada por ultrassom para o bloqueio do plexo braquial por via infraclavicular com bupivacaína a 0,5%. O ponto de inserção da agulha foi posterior à clavícula e a agulha foi avançada de cefálica para caudal. O sucesso do bloqueio foi definido como um escore composto de 14 aos 30 min após a injeção do anestésico local. O VE em 50% dos pacientes foi determinado com o método de escalonamento progressivo-regressivo de Dixon-Massey. O VE para um bloqueio bem-sucedido em 95% dos pacientes também foi calculado com regressão logística e transformação probit. Resultados: O volume mínimo efetivo (VE50) de bupivacaína a 0,5% que resultou em bloqueio bem-sucedido em 50% dos pacientes, de acordo com o método de escalonamento progressivo-regressivo, foi de 9,6 ml (intervalo de confiança de 95%, IC 5,7-13,4). O cálculo do volume mínimo efetivo necessário para um bloqueio bem-sucedido em 95% dos pacientes (VE95) com a análise de transformação probit e regressão logística foi de 23,2 ml (IC 95%, 18,8-36,7). Conclusões: O VE50 de bupivacaína a 0,5% para abordagem retroclavicular guiada por US para o bloqueio do plexo braquial por via infraclavicular foi de 9,6 ml e o VE95 calculado foi de 23,2 ml. Estudos futuros são necessários para o bloqueio do plexo braquial por via infraclavicular com diferentes abordagens, outros anestésicos locais e diferentes concentrações de bupivacaína.

Comparison of the anesthetic effects between ultrasound-guided brachial plexus block via costoclavicular approach and ultrasound-guided infraclavicular brachial plexus block via coracoid approach in operations of forearm and hand / 临床麻醉学杂志

Objective To compare the effectiveness between ultrasound-guided brachial plexus block via costoclavicular approach and ultrasound-guided infraclavicular brachial plexus block via cora-coid approach.Methods Fifty-eight patients scheduled for forearm or hand surgery,33 males and 25 females,aged 18-70 years,ASA physical status Ⅰ-Ⅲ,were selected in this study.The patients were equally randomized into two groups:the group of brachial plexus block via costoclavicular approach (group A)and group of infraclavicular brachial plexus block via coracoid approach (group B).0.5 % ropivacaine 20 ml was used for local anesthetic.The anatomic depth of brachial plexus nerve,nerve block operation time,sensory and motor blockade situation were recorded.Results Ultrasonic ima-ging showed the brachial plexus was shallower in group A (2.0±1.2)cm than in group B (3.5± 1.8)cm (P<0.05).Nerve block operation time in group A (2.0±1.5)min was less than that in group B (4.0 ± 1.5 )min (P <0.05 ).After 5 minutes and 10 minutes of the local anesthetic inj ection,the sensory blockade rate of the median nerve,the ulnar nerve,the radial nerve and the muscle cutaneous nerve in group A was higher than in group B (P<0.05).After 10 minutes of the inj ection,the motor blockade rate for the ulnar nerve,the radial nerve and the muscle cutaneous nerve was higher in group A than in group B (P<0.05).There were no dyspnea,nausea,vomiting,tinni-tus and other adverse reactions in the two groups.Conclusion The ultrasound-guided costoclaviculari brachial plexus block is more shallower than the subclavicular plexus block in the anatomic depth,and the nerve-blocked-operating time is shorter;at the same time,the former’s sensory and motor block effects is faster than the later.

A comparison of infraclavicular and supraclavicular approaches to the brachial plexus using neurostimulation / 대한마취과학회지

BACKGROUND: A prospective, double blind study was performed to compare the clinical effect of vertical infraclavicular and supraclavicular brachial plexus block using a nerve stimulator for upper limb surgery. METHODS: One hundred patients receiving upper limb surgery under infraclavicular or supraclavicular brachial plexus block were enrolled in this study. The infraclavicular brachial plexus block was performed using the vertical technique with 30 ml of 0.5% ropivacaine. The supraclavicular brachial plexus block was performed using the plumb bob technique with 30 ml of 0.5% ropivacaine. The block performance-related pain was evaluated. This study observed which nerve type was stimulated, and scored the sensory and motor block. The quality of the block was assessed intra-operatively. The duration of the sensory and motor block as well as the complications were assessed. The patient's satisfaction with the anesthetic technique was assessed after surgery. RESULTS: There were no significant differences in the block performance-related pain, frequency of the stimulated nerve type, evolution of sensory and motor block quality, or the success of the block. There were no significant differences in the duration of the sensory and motor block. There was a significant difference in the incidence of Horner's syndrome. Two patients had a pneumothorax in the supraclavicular approach. There were no significant differences in the patient's satisfaction. CONCLUSIONS: Both infraclavicular and supraclavicular brachial plexus block had similar effects. The infraclavicular approach may be preferred to the supraclavicular approach when considering the complications.

A clinical comparison of vertical infraclavicular brachial plexus block using 0.75% or 0.5% ropivacaine for upper limb surgery / 대한마취과학회지

BACKGROUND: We performed a prospective, double blind study to compare the clinical effect of vertical infraclavicular brachial plexus block produced by 0.75% vs 0.5% ropivacaine for upper limb surgery. METHODS: We included 80 patients receiving upper limb surgery under infraclavicular brachial plexus block. The infraclavicular brachial plexus block was performed via the vertical technique with 30 ml of 0.75% or 0.5% ropivacaine. By observation, we determined nerve type was stimulated and scored the level of sensory block and motor block. The quality of blocks was assessed intra-operatively. The duration of sensory block and motor block and their complications were assessed. RESULTS: There were no significant differences in the frequency of stimulated nerve type, evolution of sensory and motor block quality, or success of block. There were no significant differences in the duration of sensory block and motor block. Vascular puncture was noted in 1 patient in the 0.75% ropivacaine. CONCLUSIONS: Both the 0.75% and 0.5% ropivacaine had similar effects in the vertical infraclavicular brachial plexus block.

Comparison of vertical infraclavicular brachial plexus block with 0.5% levobupivacaine and 0.5% ropivacaine for upper limb surgery / 대한마취과학회지

BACKGROUND: We performed a prospective, double blind study to compare the clinical effect of vertical infraclavicular brachial plexus block produced by 0.5% levobupivacaine and 0.5% ropivacaine for upper limb surgery. METHODS: We included 60 patients receiving upper limb surgery under infraclavicular brachial plexus block. The infraclavicular brachial plexus block was performed via the vertical technique with 30 ml of 0.5% levobupivacaine or 0.5% ropivacaine. We observed which nerve type was stimulated and scored the sensory and motor block. The quality of block was assessed intraoperatively. The duration of sensory and motor block and complications were assessed. RESULTS: There were no significant differences in frequencies of stimulated nerve type, evolution of sensory and motor block quality, or success of block. There were no significant difference in duration of sensory block, but duration of motor block was prolonged after 0.5% levobupivacaine. There were no complications. CONCLUSIONS: Both 0.5% levobupivacaine and 0.5% ropivacaine had similar effects in the vertical infraclavicular brachial plexus block.