Document Detail

Minimum effective volume of local anesthetic for shoulder analgesia by ultrasound-guided block at root C7 with assessment of pulmonary function.
MedLine Citation:
PMID:  20975468     Owner:  NLM     Status:  MEDLINE    
BACKGROUND AND OBJECTIVES: This study was performed to determine the minimum effective volume of ropivacaine 0.75% required to produce effective shoulder analgesia for an ultrasound (US)-guided block at the C7 root level with assessment of pulmonary function.
METHODS: Using the Dixon and Massey up-and-down method study design, 20 patients scheduled for elective open shoulder surgery under combined general anesthesia and continuous interscalene brachial plexus block were included. Initial volume of ropivacaine 0.75% was 6 mL; block success or failure determined a 1-mL decrease or increase for the subsequent patient, respectively. General anesthesia was standardized. A continuous infusion of ropivacaine 0.2% was started at a rate of 6 mL/hr at 2 hrs after completion of surgery. Ventilatory function was assessed using spirometry, and movement of the hemidiaphragm was assessed by US.
RESULTS: The minimum effective volume of local anesthetic in 50% and 95% of the patients was 2.9 mL (95% confidence interval, 2.4-3.5 mL) and 3.6 mL (95% confidence interval, 3.3-6.2 mL), respectively. Ventilatory function and hemidiaphragmatic movement was not reduced up to and including 2 hrs after completion of surgery, but 22 hrs after start of the continuous infusion of ropivacaine 0.2%, ventilatory function and hemidiaphragmatic movement were significantly reduced (P < 0.001).
CONCLUSIONS: The minimum effective volume of local anesthetic for shoulder analgesia for a US-guided block at the C7 root level in 50% and 95% of the patients was 2.9 and 3.6 mL, respectively. Pulmonary function was unchanged until 2 hrs after completion surgery, but reduced 22 hrs after start of a continuous infusion of ropivacaine 0.2%.
Steven H Renes; Geert J van Geffen; Harald C Rettig; Mathieu J Gielen; Gert J Scheffer
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Publication Detail:
Type:  Clinical Trial; Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Regional anesthesia and pain medicine     Volume:  35     ISSN:  1532-8651     ISO Abbreviation:  Reg Anesth Pain Med     Publication Date:    2010 Nov-Dec
Date Detail:
Created Date:  2010-10-26     Completed Date:  2011-02-03     Revised Date:  2012-01-31    
Medline Journal Info:
Nlm Unique ID:  9804508     Medline TA:  Reg Anesth Pain Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  529-34     Citation Subset:  IM    
Department of Anesthesiology, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands.
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MeSH Terms
Amides / administration & dosage*
Analgesia / methods*
Anesthetics, Local / administration & dosage*
Cervical Vertebrae / ultrasonography
Diaphragm / drug effects*,  ultrasonography
Double-Blind Method
Infusions, Parenteral
Middle Aged
Nerve Block*
Pain Measurement
Pain, Postoperative / etiology,  prevention & control*
Prospective Studies
Pulmonary Ventilation / drug effects*
Shoulder / innervation*,  surgery
Shoulder Pain / etiology,  prevention & control*
Time Factors
Treatment Outcome
Ultrasonography, Interventional*
Reg. No./Substance:
0/Amides; 0/Anesthetics, Local; 84057-95-4/ropivacaine
Comment In:
Reg Anesth Pain Med. 2011 May-Jun;36(3):311; author reply 311-2   [PMID:  21508798 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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