Effect of local anesthetic concentration, dose and volume on the duration of single-injection ultrasound-guided axillary brachial plexus block with mepivacaine: a randomized controlled trial

Maaike G E Fenten, Karin P W Schoenmakers, Petra J C Heesterbeek, Gert Jan Scheffer, Rudolf Stienstra, Maaike G E Fenten, Karin P W Schoenmakers, Petra J C Heesterbeek, Gert Jan Scheffer, Rudolf Stienstra

Abstract

Background: In what way volume, concentration and dose affect block duration is controversial. The purpose of the present study is to investigate the effect of dose, volume and concentration of mepivacaine on the duration of sensory and motor blockade in ultrasound-guided single shot axillary brachial plexus blockade.

Methods: In this parallel group randomized trial conducted in the Sint Maartenskliniek Nijmegen, 45 adult patients undergoing minor orthopaedic forearm, wrist or hand surgery were randomized to 3 groups. Group A: 20 mL mepivacaine 1.5 %, Group B: 30 mL mepivacaine 1 % and Group C: 30 mL mepivacaine 1.5 %. Randomization was computer-generated, with allocation concealment by opaque sequentially numbered sealed envelopes. Patients and observers were blinded to group allocation.

Primary outcome measure: duration of sensory block.

Results: Forty-five patients were randomized, four patients were excluded and replaced, and 15 patients in each group were included in the analysis. Mean (95 % CI) sensory and motor block duration was 256 (230-282) and 254 (226-282) minutes in Group A, 226 (209-243) and 220 (200-240) minutes in Group B and 270 (249-291) and 264 (244-284) minutes in Group C. Duration of sensory and motor block duration differed significantly between groups (p = 0.012 and p = 0.016 respectively). Post-hoc analysis showed a significantly reduced sensory and motor block duration in Group B when compared to Group C of 44 min. No local anesthetic systemic toxicity was reported.

Conclusions: When using mepivacaine for axillary brachial plexus block, a higher dose and concentration was associated with a longer duration of sensory and motor blockade, but not a higher volume.

Trial registration: The Netherlands National Trial Register NTR3648 . Registered October 3, 2012.

Figures

Fig. 1
Fig. 1
Flowchart of patients enrolled in the study
Fig. 2
Fig. 2
Duration of overall sensory block (a) and overall motor block (b) per Group. Group A: 20 mL mepivacaine 1.5 %. Group B: 30 mL mepivacaine 1.0 %. Group C: 30 mL mepivacaine1.5 %. Dots represent individual patients, the horizontal lines with error bars represent mean with SD. *p < 0.05
Fig. 3
Fig. 3
Combined data on sensory block duration (a) and motor block duration (b) of the present study and 13 patients receiving 15 mL and 15 patients receiving 40 mL mepivacaine 1.5 % from previously published work [7]. Data are presented as mean with SD. *p < 0.005

References

    1. Marhofer P, Greher M, Kapral S. Ultrasound guidance in regional anaesthesia. Br J Anaesth. 2005;94:7–17. doi: 10.1093/bja/aei002.
    1. Casati A, Baciarello M, Cianni S, Danelli G, De Marco G, Leone S, et al. Effects of ultrasound guidance on the minimum effective anaesthetic volume required to block the femoral nerve. Br J Anaesth. 2007;98:823–7. doi: 10.1093/bja/aem100.
    1. Eichenberger U, Stöckli S, Marhofer P, Huber G, Willimann P, Kettner SC, et al. Minimal local anesthetic volume for peripheral nerve block. Reg Anesth Pain Med. 2009;34:242–6. doi: 10.1097/AAP.0b013e31819a7225.
    1. Marhofer P, Eichenberger U, Stöckli S, Huber G, Kapral S, Curatolo M, et al. Ultrasonographic guided axillary plexus blocks with low volumes of local anaesthetics: a crossover volunteer study. Anaesthesia. 2010;65:266–71. doi: 10.1111/j.1365-2044.2010.06247.x.
    1. O’Donnell BD, Iohom G. An estimation of the minimum effective anesthetic volume of 2 % lidocaine in ultrasound-guided axillary brachial plexus block. Anesthesiology. 2009;111:25–9. doi: 10.1097/ALN.0b013e3181a915c7.
    1. Eng H, Ghosh S, Chin K. Practical use of local anesthetics in regional anesthesia. Current Opin Anaesthesiol. 2014;27:382–7. doi: 10.1097/ACO.0000000000000091.
    1. Schoenmakers KPW, Wegener J, Stienstra R. Effect of local anesthetic volume (15 vs 40 mL) on the duration of ultrasound-guided single shot axillary brachial plexus block: a prospective randomized, observer-blinded trial. Reg Anesth Pain Med. 2012;37:242–7. doi: 10.1097/AAP.0b013e3182405df9.
    1. Bugamelli S, Zangheri E, Montebugnoli M, Borghi B, Ricci A, De Simone M, et al. One-day surgery for acquired forefoot deformity: sciatic nerve blockade with mepivacaine vs mepivacaine + ropivacaine: a prospective, randomized study. Minerva Anestesiol. 2007;73:57–64.
    1. Robaux S, Blunt C, Viel E, Cuvillon P, Nouguier P, Dautel G, et al. Tramadol Added to 1.5 % Mepivacaine for Axillary Brachial Plexus Block Improves Postoperative Analgesia Dose-Dependently. Anesth Analg. 2004;98:1172–7. doi: 10.1213/01.ANE.0000108966.84797.72.
    1. Serradell A. Comparison of three different volumes of mepivacaine in axillary plexus block using multiple nerve stimulation. Br J Anaesth. 2003;91:519–24. doi: 10.1093/bja/aeg215.
    1. Latzke D, Marhofer P, Zeitlinger M, Machata A, Neumann F, Lackner E, et al. Minimal local anaesthetic volumes for sciatic nerve block: evaluation of ED99 in volunteers. Br J Anaesth. 2010;104:239–44. doi: 10.1093/bja/aep368.
    1. Ponrouch M, Bouic N, Bringuier S, Biboulet P, Choquet O, Kassim M, et al. Estimation and pharmacodynamic consequences of the minimum effective anesthetic volumes for median and ulnar nerve blocks: a randomized, double-blind, controlled comparison between ultrasound and nerve stimulation guidance. Anesth Analg. 2010;111:1059–64.
    1. Fredrickson MJ, Abeysekera A, White R. Randomized study of the effect of local anesthetic volume and concentration on the duration of peripheral nerve blockade. Reg Anesth Pain Med. 2012;37:495–501. doi: 10.1097/AAP.0b013e3182580fd0.
    1. Rosenberg PH, Veering BT, Urmey WF. Naximum recommended doses of local anesthetics: a multifactorial concept. Reg Anesth Pain Med. 2004;29:564–75.
    1. Heavner JE. Let’s abandon blanket maximum recommended doses of local anesthetics. Reg Anesth Pain Med. 2004;29:524.

Source: PubMed

스폰서 및 공동 작업자

건강 상태

약물 개입

3
구독하다