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BMC Anesthesiology
Published in: BMC Anesthesiology 1/2023

Open Access 01-12-2023 | Ultrasound | Research

The Minimum Effective Concentration (MEC95) of different volumes of ropivacaine for ultrasound-guided caudal epidural block: a dose-finding study

Authors: Dongmei Ma, Yan Chen, Ping Chen, Jianhong Xu, Jian Guo, Lijia Peng

Published in: BMC Anesthesiology | Issue 1/2023

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Abstract

Background

Caudal epidural block (CEB) may be beneficial in anorectal surgery because its use may extend postoperative analgesia. This dose-finding study aimed to estimate the minimum effective anesthetic concentrations for 95% patients(MEC95) of 20 ml or 25 ml of ropivacaine in with CEB.

Patients and methods

In this double-blind, prospective study, the concentration of ropivacaine administered in 20 ml and 25 ml for ultrasound-guided CEB were determined using the sample up-and-down sequential allocation study design of binary response variables. The first participant was given 0.5% ropivacaine. Depending on whether a block was successful or unsuccessful, the concentration of local anesthesia was decreased or increased by 0.025% in the next patient. Every five minutes for 30 min, the sensory blockade using a pin-prick sensation at S3 dermatome compared to at T6 dermatome were evaluated every 5 min within 30 min. An effective CEB was defined as a a reduction of sensation at S3 dermatome and the existence of flaccid anal sphincter. Anesthesia was considered successful if the surgeon could perform the surgery without additional anesthesia. We determined the MEC50 using the Dixon and Massey up-and-down method and estimated the MEC95 using probit regression.

Results

The concentration of ropivacaine administered in 20 ml for CEB ranged from 0.2% to 0.5%. Probit regression with a bias-corrected Morris 95% CI derived by bootstrapping showed an MEC50 and MEC 50 of ropivacaine for anorectal surgical anesthesia were 0.27% (95% CI, 0.24 to 0.31) and 0.36%(95% CI, 0.32 to 0.61). The concentration of ropivacaine administered in 25 ml for CEB ranged from 0.175 to 0.5. Probit regression with a bias-corrected Morris 95% CI derived by bootstrapping showed an MEC50 and MEC95 for CEB were 0.24% (95% CI, 0.19 to 0.27) and 0.32% (95% CI, 0.28 to 0.54).

Conclusion

With ultrasound-guided CEB, the MEC95 of 0.36% ropivacaine at 20 ml and 0.32% ropivacaine at 25 ml provide adequate surgical anesthesia/analgesia 95% of patients undergoing anorectoal surgery.

Trial registration

Clinicaltrails.gov: Retrospectively registered (ChiCTR2100042954; Registration date:1/2, 2021).
Literature
1.
2.
Jaffar Al-Sa’adi MH. Assessment of surgeon performed caudal block for anorectal surgery. Asian J Surg. 2019;42(1):240–3.CrossRefPubMed
3.
Siddiqui ZI, Denman WT, Schumann R, Hackford A, Cepeda MS, Carr DB. Local anesthetic infiltration versus caudal epidural block for anorectal surgery: a randomized controlled trial. J Clin Anesth. 2007;19(4):269–73.CrossRefPubMed
4.
Asghar A, Naaz S. The volume of the caudal space and sacral canal in human sacrum. J Clin Diagn Res. 2013;7(12):2659–60.PubMedPubMedCentral
5.
Stitz MY, Sommer HM. Accuracy of blind versus fluoroscopically guided caudal epidural injection. Spine. 1999;24(13):1371–6.CrossRefPubMed
6.
Dalens B, Hasnaoui AJA. Caudal anesthesia in pediatric surgery: success rate and adverse effects in 750 consecutive patients. Analgesia. 1989;68(2):83–9.CrossRef
7.
Klocke R, Jenkinson T, Glew D. Sonographically guided caudal epidural steroid injections. J Ultrasound Med. 2003;22(11):1229–32.CrossRefPubMed
8.
Ahiskalioglu A, Yayik AM, Ahiskalioglu EO, Ekinci M, Golboyu BE, Celik EC, et al. Ultrasound-guided versus conventional injection for caudal block in children: A prospective randomized clinical study. J Clin Anesth. 2018;44:91–6.CrossRefPubMed
9.
Chen CP, Tang SF, Hsu TC, Tsai WC, Liu HP, Chen MJ, et al. Ultrasound guidance in caudal epidural needle placement. Anesthesiology. 2004;101(1):181–4.CrossRefPubMed
10.
Vadhanan P, Rajendran I, Rajasekar P. Ultrasound-Guided Caudal Epidural Anesthesia in Adults for Anorectal Procedures. Anesth Essays Res. 2020;14(2):239–42.CrossRefPubMedPubMedCentral
11.
Fang G, Wan L, Mei W, Yu HH, Luo AL. The minimum effective concentration (MEC90) of ropivacaine for ultrasound-guided supraclavicular brachial plexus block. Anaesthesia. 2016;71(6):700–5.CrossRefPubMed
12.
Takeda A, Ferraro LH, Rezende AH, Sadatsune EJ, Falcao LF, Tardelli MA. Minimum effective concentration of bupivacaine for axillary brachial plexus block guided by ultrasound. Rev Bras Anestesiol. 2015;65(3):163–9.CrossRefPubMed
13.
Kavakli AS, Kavrut Ozturk N, Arslan U. Minimum effective volume of bupivacaine 0.5% for ultrasound-guided retroclavicular approach to infraclavicular brachial plexus block. Braz J Anesthesiol. 2019;69(3):253–8.CrossRefPubMed
14.
Techasuk W, Bernucci F, Cupido T, Gonzalez AP, Correa JA, Finlayson RJ, et al. Minimum effective volume of combined lidocaine-bupivacaine for analgesic subparaneural popliteal sciatic nerve block. Reg Anesth Pain Med. 2014;39(2):108–11.CrossRefPubMed
15.
Sotthisopha T, Elgueta MF, Samerchua A, Leurcharusmee P, Tiyaprasertkul W, Gordon A, et al. Minimum Effective Volume of Lidocaine for Ultrasound-Guided Costoclavicular Block. Reg Anesth Pain Med. 2017;42(5):571–4.CrossRefPubMed
16.
Karam C, Al Assadi S, Kanazi G, Zeeni C. A sequential allocation study to determine the ED50 of Dexmedetomidine as an adjuvant to lidocaine intravenous regional anesthesia. BMC Anesthesiol. 2022;22(1):165.CrossRefPubMedPubMedCentral
17.
Zito SJ. Adult caudal anesthesia: a reexamination of the technique. AANA J. 1993;61(2):153–7.PubMed
18.
Saranteas T, Finlayson RJ, Tran DQ. Dose-finding methodology for peripheral nerve blocks. Reg Anesth Pain Med. 2014;39(6):550–5.CrossRefPubMed
19.
Dixon WJ, Massey FJ. Introduction to Statistical Analysis. 4th ed. New York: McGraw-Hill; 1983.
20.
Adebamowo CA. Caudal anaesthesia in the clinical assessment of painful anal lesions. Afr J Med Med. 2000;29(2):133–4.
21.
Kita T, Maki N, Song YS, Arai F, Nakai T. Caudal epidural anesthesia administered intraoperatively provides for effective postoperative analgesia after total hip arthroplasty. J Clin Anesth. 2007;19(3):204–8.CrossRefPubMed
22.
Oksuz G, Arslan M, Urfalioglu A, Guler AG, Teksen S, Bilal B, et al. Comparison of quadratus lumborum block and caudal block for postoperative analgesia in pediatric patients undergoing inguinal hernia repair and orchiopexy surgeries: a randomized controlled trial. Reg Anesth Pain Med. 2020;45(3):187–91.CrossRefPubMed
23.
Luz G, Innerhofer P, Häussler B, Oswald E, Salner E, Sparr H. Comparison of ropivacaine 0.1% and 0.2% with bupivacaine 0.2% for single-shot caudal anaesthesia in children. Paediatr Anaesth. 2000;10(5):499–504.CrossRefPubMed
24.
Imani F, Farahmand Rad R, Salehi R, Alimian M, Mirbolook Jalali Z, Mansouri A, et al. Evaluation of Adding Dexmedetomidine to Ropivacaine in Pediatric Caudal Epidural Block: A Randomized, Double-blinded Clinical Trial. Anesth Pain Med. 2021;11(1):e112880.CrossRefPubMedPubMedCentral
25.
Li Y, Zhou Y, Chen H, Feng Z. The effect of sex on the minimum local analgesic concentration of ropivacaine for caudal anesthesia in anorectal surgery. Anesth Analg. 2010;110(5):1490–3.CrossRefPubMed
26.
McLeod GA, Dale J, Robinson D, Checketts M, Columb MO, Luck J, et al. Determination of the EC50 of levobupivacaine for femoral and sciatic perineural infusion after total knee arthroplasty. Br J Anaesth. 2009;102(4):528–33.CrossRefPubMed
27.
Casati A, Baciarello M, Di 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(6):823–7.CrossRefPubMed
Metadata
Title
The Minimum Effective Concentration (MEC95) of different volumes of ropivacaine for ultrasound-guided caudal epidural block: a dose-finding study
Authors
Dongmei Ma
Yan Chen
Ping Chen
Jianhong Xu
Jian Guo
Lijia Peng
Publication date
01-12-2023
Publisher
BioMed Central
Published in
BMC Anesthesiology / Issue 1/2023
Electronic ISSN: 1471-2253
DOI
https://doi.org/10.1186/s12871-023-02026-y

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