Minimum effective volume of 0.5% bupivacaine with epinephrine in ultrasound-guided interscalene brachial plexus block

Falcão, Luiz Fernando R.; Perez, Marcelo Vaz; Castro, Isac de; Yamashita, Américo Massafuni; Tardelli, Maria Ângela; Amaral, José Luis Gomes do

doi:10.1093/bja/aes419

Cited by 80 publications

(32 citation statements)

References 15 publications

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“…The volume of local anesthetic used herein was selected based on our institutional practice of injecting up to 20 mL immediately lateral to the brachial plexus sheath, which was described by Spence and colleagues 20 as a "peri-plexus" injection. Given that the efficacy of injecting considerably smaller volumes of local anesthetic within the interscalene brachial plexus sheath ("intra-plexus") under US guidance is well documented, 35 it seems plausible that a lesser volume of anesthetic injected closer to the nerve roots would be equally effective to a larger volume of local anesthetic injected farther away from the nerve roots. However, the relationship between local anesthetic volume, needle-to-nerve proximity, efficacy, and most importantly, safety in the setting of US-guided nerve blockade has yet to be elucidated.…”

Section: Discussionmentioning

confidence: 99%

The Maximum Effective Needle-to-Nerve Distance for Ultrasound-Guided Interscalene Block

Albrecht

Kirkham

Taffé

et al. 2014

Regional Anesthesia and Pain Medicine

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Section: Discussionmentioning

confidence: 99%

The Maximum Effective Needle-to-Nerve Distance for Ultrasound-Guided Interscalene Block

Albrecht

Kirkham

Taffé

et al. 2014

Regional Anesthesia and Pain Medicine

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“…18 Compared with conventional neurostimulation, the addition of US conferred a 6-fold decrease in the minimal LA volume required for successful analgesia after ISB in 50% of patients (ie, MEV50). 19 Since 2011, multiple dose-finding trials using ropivacaine 0.75% or adrenalized bupivacaine 0.5% have reported successful surgical anesthesia 20 or satisfactory sensorimotor block 21,22 with US and very low volumes (5.0-7.0 mL). These encouraging results prompted many researchers to investigate the impact of US and small LA injectates on the incidence of HDP.…”

Section: Interscalene Blocks and Hemidiaphragmatic Paralysismentioning

confidence: 99%

Diaphragm-Sparing Nerve Blocks for Shoulder Surgery

Tran

Elgueta

Aliste

et al. 2017

Regional Anesthesia and Pain Medicine

175

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Shoulder surgery can result in significant postoperative pain. Interscalene brachial plexus blocks (ISBs) constitute the current criterion standard for analgesia but may be contraindicated in patients with pulmonary pathology due to the inherent risk of phrenic nerve block and symptomatic hemidiaphragmatic paralysis. Although ultrasound-guided ISB with small volumes (5 mL), dilute local anesthetic (LA) concentrations, and LA injection 4 mm lateral to the brachial plexus have been shown to reduce the risk of phrenic nerve block, no single intervention can decrease its incidence below 20%. Ultrasound-guided supraclavicular blocks with LA injection posterolateral to the brachial plexus may anesthetize the shoulder without incidental diaphragmatic dysfunction, but further confirmatory trials are required. Ultrasound-guided C7 root blocks also seem to offer an attractive, diaphragm-sparing alternative to ISB. However, additional large-scale studies are needed to confirm their efficacy and to quantify the risk of periforaminal vascular breach. Combined axillary-suprascapular nerve blocks may provide adequate postoperative analgesia for minor shoulder surgery but do not compare favorably to ISB for major surgical procedures. One intriguing solution lies in the combined use of infraclavicular brachial plexus blocks and suprascapular nerve blocks. Theoretically, the infraclavicular approach targets the posterior and lateral cords, thus anesthetizing the axillary nerve (which supplies the anterior and posterior shoulder joint), as well as the subscapular and lateral pectoral nerves (both of which supply the anterior shoulder joint), whereas the suprascapular nerve block anesthetizes the posterior shoulder. Future randomized trials are required to validate the efficacy of combined infraclavicular-suprascapular blocks for shoulder surgery.

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“…[9][10][11] Despite the onslaught of new publications, the optimal methodology remains ambiguous. Whereas the Dixon-Mood up-and-down method remains most prevalent, [9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26] recent trials have advocated using a Biased Coin Design variant. [27][28][29][30][31] Alternately, 3 studies published in 2013 used Bayesian analysis and the Continual Reassessment Method.…”

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confidence: 99%

Dose-Finding Methodology for Peripheral Nerve Blocks

Saranteas

Finlayson

Tran

2014

Regional Anesthesia and Pain Medicine

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Dose-finding studies enable the successful conduct of peripheral nerve blocks by ensuring the administration of appropriate doses of local anesthetic. However, the optimal dose-finding methodology remains ambiguous. In this research methodology article, we set out to review the basic aspects pertaining to dose-response curves (graded vs quantal), the pharmacodynamic indices required by dose-finding studies, the properties of different dose-finding methods (sigmoidal dose-response curve analysis, Dixon-Mood method, Biased Coin Design, and Bayesian analysis), as well as strategies and recommendations for future research.

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Minimum effective volume of 0.5% bupivacaine with epinephrine in ultrasound-guided interscalene brachial plexus block

Abstract: The MEV(90) of 0.5% bupivacaine with epinephrine (1:200 000) for US-guided ISBPB was 0.95 ml. Adequate postoperative analgesia and a reduced incidence of diaphragmatic block can be obtained using from 2.34 to 4.29 ml. ClinicalTrials.gov. Registry NCT01244932.

Cited by 80 publications

References 15 publications

The Maximum Effective Needle-to-Nerve Distance for Ultrasound-Guided Interscalene Block

The Maximum Effective Needle-to-Nerve Distance for Ultrasound-Guided Interscalene Block

Diaphragm-Sparing Nerve Blocks for Shoulder Surgery

Dose-Finding Methodology for Peripheral Nerve Blocks

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