Sivakumar Ranjith Kumar, Karmakar Manoj Kumar, Wong Rosinni S L, Samy Winnie
From the Department of Anaesthesia and Intensive Care, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong S.A.R, The Peoples' Republic of China (RKS, MKK, RSLW, WS).
Eur J Anaesthesiol. 2025 Sep 1;42(9):800-807. doi: 10.1097/EJA.0000000000002160. Epub 2025 Mar 11.
Selective trunk block (SeTB) targets the three trunks of the brachial plexus and produces surgical anaesthesia of the entire upper extremity, including the shoulder. However, the optimal dose of local anaesthetic (LA) required for a SeTB is not known.
This study aimed to evaluate the minimum effective volume 90% (MEV90) of LA required for a SeTB.
Quantal bioassay.
Single-centre, University hospital in Hong Kong S.A.R, China.
After ethical approval, 25 ASA I to III patients, aged 18 to 75 years, undergoing upper extremity surgery under an ultrasound-guided (USG) SeTB were included.
The volume of the LA (1 : 1 mixture of 2% lidocaine with 5 μg ml -1 epinephrine and 0.5% levobupivacaine) used, starting with 21 ml, was assigned by either increasing or decreasing 3 ml (1 ml each trunk), based on the modified Narayana sequential design.
Readiness for surgery (sensory score ≤30 and motor score ≤1) at or within 30 min after the injection was the primary outcome measure. A successful block was defined as achieving readiness for surgery within 30 min and completing the intended surgery without rescue analgesia or conversion to general anaesthesia. The MEV90 was estimated using centred isotonic regression.
The MEV90 of the LA mixture for USG SeTB was 24.7 [95% confidence interval (CI), 23.8 to 28.9] ml. The median [IQR] time to 'readiness for surgery' and 'complete anaesthesia' was 6.6 [5 to 12.3] and 15 [7.3 to 18] minutes, respectively.
The MEV90 of a 1 : 1 LA mixture for USG SeTB to produce surgical anaesthesia of the entire upper extremity (except for the T2 dermatome), using readiness for surgery as the success criterion, is 24.7 ml (95% CI, 23.8 to 28.9) ml.
ClinicalTrials.gov, Trial Registration No: NCT04773405.
选择性躯干阻滞（SeTB）针对臂丛神经的三个干，可对包括肩部在内的整个上肢产生手术麻醉效果。然而，SeTB所需的局部麻醉药（LA）最佳剂量尚不清楚。
本研究旨在评估SeTB所需的局部麻醉药最小有效量90%（MEV90）。
质反应生物测定法。
中国香港特别行政区的一家单中心大学医院。
经伦理批准，纳入25例年龄在18至75岁之间、美国麻醉医师协会（ASA）分级为I至III级、在超声引导（USG）下接受SeTB进行上肢手术的患者。
根据改良的纳拉亚纳序贯设计，起始使用21 ml的LA（2%利多卡因与5 μg/ml肾上腺素和0.5%左旋布比卡因的1∶1混合液），每次增加或减少3 ml（每个干1 ml）。
注射后30分钟内或30分钟时达到手术准备状态（感觉评分≤30且运动评分≤1）是主要观察指标。成功阻滞定义为在30分钟内达到手术准备状态，并在无需补救镇痛或转为全身麻醉的情况下完成预期手术。使用中心化等渗回归法估计MEV90。
USG SeTB的LA混合液的MEV90为24.7 [95%置信区间（CI），23.8至28.9] ml。达到“手术准备状态”和“完全麻醉”的中位[四分位间距]时间分别为6.6 [5至12.3]分钟和15 [7.3至18]分钟。
以达到手术准备状态为成功标准，USG SeTB用于对整个上肢（T2皮节除外）产生手术麻醉的1∶1 LA混合液的MEV90为24.7 ml（95% CI，23.8至28.9）ml。
ClinicalTrials.gov，试验注册号：NCT04773405。
