A randomized trial to determine the minimum effective lidocaine volume for median nerve block using hydrodissection

Eric Dufour, Souhail Jaziri, Marie Alice Novillo, Lila Aubert, Anne Chambon, Rainer Kutz, Alexandre Vallée, Marc Fischler, Eric Dufour, Souhail Jaziri, Marie Alice Novillo, Lila Aubert, Anne Chambon, Rainer Kutz, Alexandre Vallée, Marc Fischler

Abstract

Ultrasound-guided hydrodissection with 5% dextrose in water (DW5) creates a peri-nervous compartment, separating the nerve from the neighboring anatomical structures. The aim of this randomized study was to determine the minimum volume of lidocaine 2% with epinephrine 1:200,000 required when using this technique to achieve an effective median nerve block at the elbow in 95% of patients (MEAV95). Fifty-two patients scheduled for elective hand surgery received an ultrasound-guided circumferential perineural injection of 4 ml DW5 and an injection of local anesthetic (LA) following a biased coin up-and-down sequential allocation method. A successful block was defined as a light touch completely suppressed on the two distal phalanges of the index finger within a 30-min evaluation period. The MEAV95 of lidocaine 2% with epinephrine was 4 ml [IQR 3.5-4.0]. Successful median nerve block was obtained in 38 cases (82.6%) with median onset time of 20.0 [10.0-21.2] minutes (95% CI 15-20). The analgesia duration was 248 [208-286] minutes (95% CI 222-276). Using an ultrasound-guided hydrodissection technique with DW5, the MEAV95 to block the median nerve at the elbow with 2% lidocaine with epinephrine was 4 ml [IQR 3.5-4.0]. This volume is close to that usually recommended in clinical practice.Trial registration clinicaltrials.gov. NCT02438657, Date of registration: May 8, 2015.

Conflict of interest statement

The authors declare no competing interests.

© 2022. The Author(s).

Figures

Figure 1
Figure 1
Flow chart.
Figure 2
Figure 2
Repartition of onset time for successful block according to the sensory and motor test results.
Figure 3
Figure 3
Relation between LA volume and block onset time for successful blocks. A successful block was defined by a score = 2 with a light touch felt on the P2 or P3 of the index finger.
Figure 4
Figure 4
Up-and-down evolution for median nerve block in patients receiving an ultrasound-guided median nerve block using hydrodissection with DW5 and 2% lidocaine with epinephrine.

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Source: PubMed

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