Minimum Effective Volume of Lidocaine for Ultrasound-Guided Costoclavicular Block

Abstract

For ultrasound-guided costoclavicular block, the MEV90 of lidocaine 1.5% with epinephrine 5 μg/mL is 34 mL. Further dose-finding studies are required for other concentrations of lidocaine, other local anesthetic agents, and multiple-injection techniques.

Randomized comparison between interscalene and costoclavicular blocks for arthroscopic shoulder surgery

“…In a recent dose-finding study, we reported that the minimum effective volume of adrenalized lidocaine 1.5% in 90% of patients (MEV90) is 34 mL for CCB 23. However, in the current trial, we intentionally selected the smaller volume (20 mL) previously recommended by Karmakar et al 11.…”

Costoclavicular brachial plexus block reduces hemidiaphragmatic paralysis more than supraclavicular brachial plexus block: retrospective, propensity score matched cohort study

“…Due to the anatomical advantages of the costoclavicular space [21,33], a relatively small Oh, et al volume of local anesthetic was administered compared with the conventional infraclavicular brachial plexus block and the results were successful [19,20,22]. In contrast, a dose-finding study for ultrasound-guided CCB with 1.5% lidocaine revealed that the minimum effective volume in 90% of patients was 34 mL [10]. The differences among studies may be due to differences in the details of the injection techniques, such as the injection duration and pressure limit, as well as differences in the definition of successful blockade [10,19,22].…”

“…Hemidiaphragmatic paralysis (HDP) is a frequent complication of the brachial plexus block, caused by uninten-tional blockade of the phrenic nerve, especially when the block is performed above the clavicle [1][2][3][4][5][6][7]. Although HDP can reduce forced vital capacity and forced expiratory volume at 1 second by 20%-30% [8][9][10], these reductions are Background: Hemidiaphragmatic paralysis, a frequent complication of the brachial plexus block performed above the clavicle, is rarely associated with an infraclavicular approach. The costoclavicular brachial plexus block is emerging as a promising infraclavicular approach.…”

Ultrasound-Guided Infraclavicular Brachial Plexus Block

“…1 Such a strategy is justified given that there is a paucity of dose-finding data for the CC approach. 17 However, it may also be criticized because the volume used is the minimum effective volume in 90% of patients (MEV 90 ) for 1.5% lidocaine 1,17 and not for the LA mixture used by Leurcharusmee and colleagues. 13 In our opinion, 35 mL of local anesthetic is excessive for the CC approach because rapid onset of surgical anesthesia is readily achieved with only 20 to 25 mL of 0.5% ropivacaine, 11 as seen in this study.…”