Effective low dosage of mepivacaine in ultrasound-guided axillary nerve block: a double-blinded, randomized clinical trial of efficacy in patients undergoing distal upper extremity surgery

• Published in: Journal of clinical anesthesia Vol. 26; no. 3; pp. 222 - 226
• Main Authors: Perov, Samuel, MD, Patel, Pranav, MD, Kumar, Sanjeev, MD, McKelvey, George M., PhD, Chidiac, Elie, MD, Motlani, Faisal, MD
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01-05-2014; Elsevier; Elsevier Limited
• Subjects: Adult; Ambulatory Surgical Procedures - methods; Anesthesia; Anesthesia & Perioperative Care; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Anesthetics, Local - administration & dosage; Axillary plexus block; Biological and medical sciences; Brachial Plexus; Confidence intervals; Demographics; Dose-Response Relationship, Drug; Double-Blind Method; Female; Functional block; Humans; Male; Medical sciences; Mepivacaine; Mepivacaine - administration & dosage; Middle Aged; Nerve Block - methods; Pain Medicine; Prospective Studies; Regional anesthesia; Surgery; Surgical block; Time Factors; Ultrasonic imaging; Ultrasonography, Interventional; Ultrasound-guided; Upper Extremity - surgery; Veins & arteries; Mepivacaine; Regional anesthesia; Functional block; Ultrasound-guided; Axillary plexus block; Surgical block; Human; Upper extremity; Axillary nerve; Local anesthetic; Randomization; Efficiency; Surgery; Distal; Double blind study; Block; Clinical trial; Organic amide; Ultrasound; Axillary
• ISSN: 0952-8180; 1873-4529
• DOI: 10.1016/j.jclinane.2013.11.016

Abstract Study Objective To evaluate two low-dose volumes (20 mL or 30 mL) of 1.5% mepivacaine solution used for ultrasound-guided axillary blockade for outpatients undergoing distal upper limb surgery. Design Prospective, double-blinded randomized study. Setting Outpatient surgical setting of a university-affiliated hospital. Patients 64 adult, ASA physical status 1, 2, and 3 patients, aged 28-46 years, scheduled for upper limb surgery. Interventions Patients were randomized to two groups to receive either 20 mL of 1.5% mepivacaine solution (n=31) or 30 mL of 1.5% mepivacaine solution (n=33) for ultrasound-guided axillary plexus blockade. Measurements Block duration, proportion of surgical and functional successful blocks, onset of sensory and motor blockade measured from 0 to 30 minutes following final needle extraction, total amount of preoperative sedative (midazolam), and intraoperative propofol administered were recorded. Main Results Following axillary plexus blockade, neither patient group showed any statistically significant difference in the percentage of functionally successful blockade (30 mL, 100%: 20 mL, 97%; P = 0.48), surgically successful blockade (30 mL, 100%; 20 mL, 94%; P = 0.23), cumulative sensory or motor blockade surgical time, block performance time, preoperative midazolam use, or intraoperative propofol use. Conclusion Low volumes (30 mL or 20 mL) of 1.5% mepivacaine provides satisfactory anesthesia for ambulatory distal upper limb surgery with no significant difference in clinical outcomes.