The estimation of minimum effective volume of 0.5% ropivacaine in ultrasound-guided interscalene brachial plexus nerve block: A clinical trial

Mittal, Kailash; Janweja, Sarita; Prateek, S; Sangwan, Pushpender; Agarwal, Deepa; Tak, Himani

doi:10.4103/joacp.joacp_70_18

Cited by 6 publications

(4 citation statements)

References 23 publications

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“…In general, lower volume and concentration of the LA are less likely to produce clinical symptoms of phrenic nerve paralysis but are additionally less likely to produce a dense enough block to provide adequate analgesia. Starting with volume, a prior study noted a minimum effective volume for 90% of patients as 8.64 mL of 0.5% ropivacaine [ 12 ]. Other previous studies have mentioned utilizing 5 mL of ropivacaine 0.5% or 0.75% as an effective dose for ISB with less likelihood of respiratory complications [ 8 , 15 ].…”

Section: Discussionmentioning

confidence: 99%

“…This is due to compensation from the contralateral diaphragm and is most likely to occur in patients with adequate pulmonary reserve [9]. This nerve block is relatively contraindicated in patients with significant underlying pulmonary disease, especially chronic obstructive pulmonary disease (COPD), as the ISB has been shown to frequently result in a significant reduction in forced expiratory volume at one second (FEV1) [10][11][12][13]. In addition to COPD patients, the block is absolutely contraindicated in patients with a history of contralateral phrenic nerve damage.…”

Section: Introductionmentioning

confidence: 99%

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A Case of Hospitalization After Pre-operative Interscalene Nerve Block in an Ambulatory Surgery Center

Desai,

Willson,

Chitty

et al. 2024

Cureus

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Interscalene nerve block (ISB) is an effective and low-risk local anesthetic (LA) procedure that is commonly employed for shoulder surgery. While phrenic nerve involvement occurs to some degree in every ISB procedure, the incidence of hypoxemia and other clinical signs of diaphragmatic disruption is much lower. This is a case of a 36-year-old female with no underlying respiratory disease who developed hypoxemia requiring a night of observation following an ISB for a rotator cuff repair procedure in an ambulatory surgical center. Her hypoxemia was easily treated with supplemental oxygen and she made a full recovery by the next day. The use of ultrasound guidance, reduced LA volume, less potent medication, sterile fluid for optimal visualization, and extrafascial administration should be considered for all patients receiving an ISB to prevent respiratory complications.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

A Case of Hospitalization After Pre-operative Interscalene Nerve Block in an Ambulatory Surgery Center

Desai,

Willson,

Chitty

et al. 2024

Cureus

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“…This BCD approach avoids the drawback of estimating ED 95 using unproven ED 50 ( Pace and Stylianou, 2007 ; Tang et al, 2020 ; Zhu et al, 2020 ; Ni et al, 2022 ) because the peak dose distribution of ED 50 is similar to the average. Therefore, the BCD method combined with the estimation of isotonic regression is often used in anesthesia studies ( Mittal et al, 2019 ; Kewlani et al, 2021 ; Wu et al, 2021 ).…”

Section: Discussionmentioning

confidence: 99%

Determination of the 95% effective dose of remimazolam tosylate in anesthesia induction inhibits endotracheal intubation response in senile patients

Liu

Ouyang

et al. 2023

Front. Pharmacol.

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Background and Purpose: The prevalence of elderly patients prompts anesthesiologists to determine the optimal dose of medication due to the altered pharmacokinetics and pharmacodynamics of this population. The present study aimed to determine the 95% effective dose (ED95) of remimazolam tosylate in anesthesia induction to inhibit endotracheal intubation-related cardiovascular reaction in frail and non-frail senile patients.Methods: A prospective sequential allocation dose-finding study of remimazolam tosylate was conducted on 80 elderly patients who received general anesthesia between May and June 2022 at the First Affiliated Hospital of Nanchang University. The initial dose was 0.3 mg/kg. The blood pressure and heart rate fluctuations during intubation were either <20% (negative cardiovascular response) or ≥20% (positive cardiovascular response). If positive, the dose of the next patient was increased by 0.02 mg/kg, while if negative, it was reduced by 0.02 mg/kg according to the 95:5 biased coin design (BCD). The ED95 and 95% confidence intervals (CIs) were determined using R-Foundation isotonic regression and bootstrapping methods.Results: The ED95 of remimazolam tosylate to inhibit the response during tracheal intubation was 0.297 mg/kg (95% CI: 0.231–0.451 mg/kg) and 0.331 mg/kg (95% CI: 0.272–0.472 mg/kg) in frail and non-frail senile patients, respectively.Conculation and Implications: The CI of the two groups overlap, and no difference was detected in the ED95 of remimazolam tosylate in inhibiting endotracheal intubation-related cardiovascular response in frail and non-frail senile patients. These results suggested that remimazolam tosylate is an optimal anesthesia inducer for all elderly patients.Clinical Trial Registration:https://www.chictr.org.cn, identifier ChiCTR2200055709.

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“…Mittal et al [8] determined that the minimum effective volume of 0.5% ropivacaine was 8.64 mL in 90% of patients who underwent ISB without deterioration in the block onset and duration. A similar study by Vandepitte et al [9] found that effective dose 95% (ED95) of 0.75% ropivacaine was 7 mL for successful surgical anesthesia with ISB using a catheter.…”

Section: Discussionmentioning

confidence: 99%

Local anesthetic volume in ultrasound-guided interscalene block and opioid consumption during shoulder arthroscopic surgery

Lim

Lee

et al. 2021

Medicine

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Interscalene block (ISB) is commonly performed for regional anesthesia in shoulder surgery. Ultrasound-guided ISB enables visualization of the local anesthetic spread and a reduction in local anesthetic volume. However, little is known about the appropriate local anesthetic dose for surgical anesthesia without sedation or general anesthesia. The purpose of our study was to evaluate the appropriate local anesthetic volume by comparing intraoperative analgesics and hemodynamic changes in ISB in arthroscopic shoulder surgery. Overall, 1007 patients were divided into groups 1, 2, and 3 according to the following volume of local anesthetics: 10–19, 20–29, and 30–40 mL, respectively. The use of intraoperative analgesics and sedatives, and the reduction in intraoperative maximum blood pressure and heart rate were compared through retrospective analysis. Fentanyl was used in 55.6% of patients in group 1, which was significantly higher than in those groups 2 and 3 (22.3% and 30.7%, respectively); furthermore, it was also higher than those in groups 2 and 3 in dose-specific comparisons ( P < .05). The percent of the maximum reduction in intraoperative systolic blood pressure and heart rate in group 3 was significantly higher than those in groups 1 and 2. Ephedrine administration was lower in group 2 than that in other groups ( P < .05). The incidence of hypotensive bradycardic events was lowest (9.1%) at the local anesthetic volume of 24 mL as revealed by the quadratic regression analysis ( R 2 = 0.313, P = .003). Decreasing the local anesthetic volume to less than 20 mL for ultrasound-guided ISB as the sole anesthesia increases the opioid consumption during shoulder arthroscopic surgery. Local anesthetics >30 mL or increased opioid consumption with <20 mL of local anesthetics could increase the risk of cardiovascular instability intraoperatively. Our findings indicate that 24 mL of local anesthetic could be used to lower the incidence of hypotensive bradycardic events.

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The estimation of minimum effective volume of 0.5% ropivacaine in ultrasound-guided interscalene brachial plexus nerve block: A clinical trial

Cited by 6 publications

References 23 publications

A Case of Hospitalization After Pre-operative Interscalene Nerve Block in an Ambulatory Surgery Center

A Case of Hospitalization After Pre-operative Interscalene Nerve Block in an Ambulatory Surgery Center

Determination of the 95% effective dose of remimazolam tosylate in anesthesia induction inhibits endotracheal intubation response in senile patients

Local anesthetic volume in ultrasound-guided interscalene block and opioid consumption during shoulder arthroscopic surgery

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