Determination of the minimum effective volume of 0.5% bupivacaine for ultrasound-guided axillary brachial plexus block

Background and objective: The use of ultrasound for needle correct placement and local anesthetic spread monitoring helped to reduce the volume of local anesthetic required for peripheral nerve blocks. There are few studies of the minimum effective volume of local anesthetic for axillary brachial plexus block. The aim of this study was to determine the minimum effective volume (VE90) of 0.5% bupivacaine with epinephrine (1:200,000) for ultrasound guided ABPB. Method: Massey and Dixon's up-and-down method was used to calculate the minimum effective volume. The initial dose was 5 mL per nerve (radial, median, ulnar, and musculocutaneous). In case of blockade failure, the volume was increased to 0.5 mL per nerve. A successful blockade resulted in decreased volume of 0.5 mL per nerve to the next patient. Successful blockade was defined as a motor block ≤2, according to the modified Bromage scale; lack of thermal sensitivity; and response to pinprick. The achievement of five cases of failure followed by success cases was defined as criterion to complete the study. Results: 19 patients were included in the study. The minimum effective volume (VE90) of 0.5% bupivacaine with 1:200,000 epinephrine was 1.56 mL (95% CI, 0.99–3.5) per nerve. Conclusion: This study is in agreement with some other studies, which show that it is possible to achieve surgical anesthesia with low volumes of local anesthetic for ultrasound-guided peripheral nerve blocks. Keywords: Regional anesthesia, Brachial plexus, Minimum volume, Ultrasound, Bupivacain