Department of Anesthesiology, The 960th Hospital of PLA, Jinan, China.
Department of Anesthesiology, The First Affiliated Hospital of Dali University, Dali, Yunnan Province, China.
Anaesthesiologie. 2023 Dec;72(Suppl 1):39-43. doi: 10.1007/s00101-023-01344-7. Epub 2023 Oct 18.
Ultrasound-guided supraclavicular brachial plexus block is widely used in upper limb surgery; however, it requires a higher dose (20-30 mL) of local anesthetic. In this study, we aimed to determine the 90% minimum effective volume for ultrasound-guided supraclavicular brachial plexus block.
All patients received an ultrasound-guided two-point injection of 0.5% ropivacaine at a starting volume of 0.18 mL/mm cross-sectional nerve area. In cases of a successful block, the next patient had the same volume with a probability of 0.89, and the volume was reduced by 0.04 mL/mm cross-sectional nerve area with a probability of 0.11. When the block failed, the dose was increased by 0.04 mL/mm cross-sectional nerve area. After 45 cases of successful blocks, the 90% minimum effective volume of local anesthetic was calculated using the centered isotonic regression function.
Centered isotonic regression analysis resulted in a 90% minimum effective volume and a 95% confidence interval of 0.189 mL/mm and 0.176-0.225 mL/mm for the supraclavicular brachial plexus block.
A good blocking effect can be achieved with 0.189 mL/mm of 0.5% ropivacaine with more precise dosing, thereby reducing the risk of local anesthetic poisoning.
超声引导锁骨上臂丛神经阻滞在上肢手术中广泛应用，但需要更高剂量（20-30ml）的局部麻醉剂。本研究旨在确定超声引导锁骨上臂丛神经阻滞的 90%最小有效容积。
所有患者均接受 0.5%罗哌卡因的超声引导两点注射，起始容积为 0.18ml/mm 神经截面积。如果阻滞成功，下一位患者的相同容积的概率为 0.89，容积以 0.11 的概率减少 0.04ml/mm 神经截面积。如果阻滞失败，剂量增加 0.04ml/mm 神经截面积。在成功完成 45 例阻滞之后，使用中心等渗回归函数计算局部麻醉剂的 90%最小有效容积。
中心等渗回归分析得出，锁骨上臂丛神经阻滞的 90%最小有效容积和 95%置信区间分别为 0.189ml/mm 和 0.176-0.225ml/mm。
使用 0.5%罗哌卡因 0.189ml/mm 可以达到良好的阻滞效果，剂量更精确，从而降低局部麻醉中毒的风险。
