Median effective volume of ropivacaine 0.5% for ultrasound-guided adductor canal block

Yan Tao, Shao-Qiang Zheng, Tao Xu, Geng Wang, Yun Wang, An-Shi Wu, Yun Yue, Yan Tao, Shao-Qiang Zheng, Tao Xu, Geng Wang, Yun Wang, An-Shi Wu, Yun Yue

Abstract

Objective This study aimed to identify the median effective volume of ropivacaine 0.5% for ultrasound-guided adductor canal block (ACB). Methods Thirty-two patients received ultrasound-guided ACB for knee arthroscopic meniscectomy. The criterion for successful ACB was the loss of pinprick sensation in the saphenous area (medial knee, leg, and foot). The volume of ropivacaine 0.5% in each case was determined using the up-down method and used for calculating the median effective dose. Results The mean age, weight, and height of patients were 28.6 ± 7.1 years, 68.2 ± 10.6 kg, and 172.5 ± 6.4 cm, respectively. Among patients who received 18- and 15-mL doses, ACB was successful in all four cases. Among patients who received a 12-mL dose, ACB was effective in eight and ineffective in two cases. Among patients who received a 10-mL dose, ACB was successful in six and unsuccessful in seven cases. In patients who received an 8-mL dose, ACB was ineffective in all five cases. The median effective volume of ropivacaine 0.5% was 10.4 mL (95% confidence interval, 9.1-11.4 mL). In all effective cases, the median quadriceps strength was grade 5. Conclusions The median effective volume of ropivacaine 0.5% is 10.4 mL for ultrasound-guided ACB.

Keywords: Adductor canal block; effective dose; knee arthroscopic meniscectomy; quadriceps femoris muscle; ropivacaine; saphenous nerve; ultrasonography.

Figures

Figure 1.
Figure 1.
Ultrasound image of the adductor canal and puncturing needle.
Figure 2.
Figure 2.
Ultrasound image of the site of ropivacaine injection (white dots).
Figure 3.
Figure 3.
Sequential responses to effective (black) and ineffective (white) ropivacaine 0.5% doses by the up-down method.

References

    1. van der Wal M, Lang SA, Yip RW. Transsartorial approach for saphenous nerve block. Can J Anaesth 1993; 40: 542–546.
    1. Tsai PB, Karnwal A, Kakazu C, et al. Efficacy of an ultrasound-guided subsartorial approach to saphenous nerve block: a case series. Can J Anaesth 2010; 57: 683–688.
    1. Jenstrup MT, Jæger P, Lund J, et al. Effects of adductor-canal-blockade on pain and ambulation after total knee arthroplasty: a randomized study. Acta Anaesthesiol Scand 2012; 56: 357–364.
    1. Scholten FG, Warnars GA, Mali WP, et al. Femoropopliteal occlusions and the adductor canal hiatus, Duplex study. Eur J Vasc Surg 1993; 7: 680–683.
    1. Hanson NA, Derby RE, Auyong DB, et al. Ultrasound-guided adductor canal block for arthroscopic medial meniscectomy: a randomized, double-blind trial. Can J Anaesth 2013; 60: 874–880.
    1. Abdallah FW, Whelan DB, Chan VW. Adductor canal block provides noninferior analgesia and superior quadriceps strength compared with femoral nerve block in anterior cruciate ligament reconstruction. Anesthesiology 2016; 124: 1053–1064.
    1. Jaeger P, Zaric D, Fomsgaard JS, et al. Adductor canal block versus femoral nerve block for analgesia after total knee arthroplasty: a randomized, double-blind study. Reg Anesth Pain Med 2013; 38: 526–532.
    1. Xu T, Wang J, Wang G, et al. Relative potency ratio between hyperbaric and isobaric solutions of ropivacaine in subarachnoid block for knee arthroscopy. Int J Clin Exp Med 2015; 8: 9603–9606.
    1. Cappelleri G, Aldegheri G., Ruggieri F, et al. Minimum effective anesthetic concentration (MEAC) for sciatic nerve block: subghteus and popliteal approaches. Can J Anaesth 2007; 54: 283–289.
    1. Dixon WJ, Massey FJ. Sensitivity experiments In: Introduction to statistical analysis. 4th ed New York: McGraw-Hill, 1983, pp 428–439.
    1. Bertini L, Tagariello V, Mancini S, et al. 0.75% and 0.5% ropivacaine for axillary brachial plexus block: a clinical comparison with 0.5% bupivacaine. Reg Anesth Pain Med 1999; 24: 514–518.
    1. Venkatesh RR, Kumar P, Trissur RR, et al. A randomized controlled study of 0.5% bupivacaine, 0.5% ropivacaine and 0.75% ropivacaine for supraclavicular brachial plexus block. J Clin Diagn Res 2016; 10: UC09–UC012.
    1. Zhang W, Hu Y, Tao Y, et al. Ultrasound-guided continuous adductor canal block for analgesia after total knee replacement. Chin Med J (Engl) 2014; 127: 4077–4081.
    1. Joe HB, Choo HS, Yoon JS, et al. Adductor canal block versus femoral nerve block combined with sciatic nerve block as an anesthetic technique for hindfoot and ankle surgery: a prospective, randomized noninferiority trial. Medicine (Baltimore) 2016; 95: e5758.
    1. Li D, Tan Z, Kang P, et al. Effects of multi-site infiltration analgesia on pain management and early rehabilitation compared with femoral nerve or adductor canal block for patients undergoing total knee arthroplasty: a prospective randomized controlled trial. Int Orthop 2017; 41: 75–83.
    1. Espelund M, Fomsgaard JS, Haraszuk J, et al. Analgesic efficacy of ultrasound-guided adductor canal blockade after arthroscopic anterior cruciate ligament reconstruction. Eur J Anaesthesiol 2013; 30: 422–428.
    1. Lund J, Jenstrup MT, Jaeger P, et al. Continuous adductor-canal-blockade for adjuvant post-operative analgesia after major knee surgery: preliminary results. Acta Anaesthesiol Scand 2011; 55: 14–19.
    1. Davis JJ, Bond TS, Swenson JD. Adductor canal block: more than just the saphenous nerve? Reg Anesth Pain Med 2009; 34: 618–619.
    1. Jaeger P, Grevstad U, Henningsen MH, et al. Effect of adductor-canal-blockade on established, severe post-operative pain after total knee arthroplasty: a randomised study. Acta Anaesthesiol Scand 2012; 56: 1013–1019.
    1. Espelund M, Grevstad U, Jaeger P, et al. Adductor canal blockade for moderate to severe pain after arthroscopic knee surgery: a randomized controlled trial. Acta Anaesthesiol Scand 2014; 58: 1220–1227.
    1. Andersen HL, Andersen SL, Tranum-Jensen J. The spread of injectate during saphenous nerve block at the adductor canal: a cadaver study. Acta Anaesthesiol Scand 2015; 59: 238–245.
    1. Jæger P, Jenstrup MT, Lund J, et al. Optimal volume of local anaesthetic for adductor canal block: using the continual reassessment method to estimate ED95. Br J Anaesth 2015; 115: 920–926.
    1. Jæger P, Koscielniak-Nielsen ZJ, Hilsted KL, et al. Adductor canal block with 10 mL versus 30 mL local anesthetics and quadriceps strength: a paired, blinded, randomized study in healthy volunteers. Reg Anesth Pain Med 2015; 40: 553–558.
    1. Montgomery SH, Shamji CM, Yi GS, et al. Effect of nerve stimulation use on the success rate of ultrasound-guided subsartorial saphenous nerve block: a randomized controlled trial . Reg Anesth Pain Med 2017; 42: 25–31.
    1. Jæger P, Koscielniak-Nielsen ZJ, Hilsted KL, et al. Effect of total dose of lidocaine on duration of adductor canal block, assessed by different test methods: a report of two blinded, randomized, crossover studies in healthy volunteers. Anesth Analg 2016; 123: 1026–1032.

Source: PubMed

赞助者和合作者

医疗条件

药物干预

3
订阅