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BMC Anesthesiology
Published in: BMC Anesthesiology 1/2015

Open Access 01-12-2015 | Research article

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

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

Published in: BMC Anesthesiology | Issue 1/2015

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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.
Literature
1.
Marhofer P, Greher M, Kapral S. Ultrasound guidance in regional anaesthesia. Br J Anaesth. 2005;94:7–17.CrossRefPubMed
2.
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.CrossRefPubMed
3.
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.CrossRefPubMed
4.
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.CrossRefPubMed
5.
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.CrossRefPubMed
6.
Eng H, Ghosh S, Chin K. Practical use of local anesthetics in regional anesthesia. Current Opin Anaesthesiol. 2014;27:382–7.CrossRef
7.
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.CrossRefPubMed
8.
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.PubMed
9.
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.CrossRefPubMed
10.
Serradell A. Comparison of three different volumes of mepivacaine in axillary plexus block using multiple nerve stimulation. Br J Anaesth. 2003;91:519–24.CrossRefPubMed
11.
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.CrossRefPubMed
12.
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.PubMed
13.
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.CrossRefPubMed
14.
Rosenberg PH, Veering BT, Urmey WF. Naximum recommended doses of local anesthetics: a multifactorial concept. Reg Anesth Pain Med. 2004;29:564–75.PubMed
15.
Heavner JE. Let’s abandon blanket maximum recommended doses of local anesthetics. Reg Anesth Pain Med. 2004;29:524.PubMed
Metadata
Title
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
Authors
Maaike G. E. Fenten
Karin P. W. Schoenmakers
Petra J. C. Heesterbeek
Gert Jan Scheffer
Rudolf Stienstra
Publication date
01-12-2015
Publisher
BioMed Central
Published in
BMC Anesthesiology / Issue 1/2015
Electronic ISSN: 1471-2253
DOI
https://doi.org/10.1186/s12871-015-0110-0

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