Article Text

Download PDFPDF
A Randomized Comparison Between 3 Combinations of Volume and Concentration of Lidocaine for Ultrasound-Guided Infraclavicular Block
  1. Andrea P. González, MD,
  2. Francisca Bernucci, MD,
  3. Wallaya Techasuk, MD,
  4. Kevin Pham,
  5. Roderick J. Finlayson, MD, FRCPC and
  6. De Q.H. Tran, MD, FRCPC
  1. Department of Anesthesia, Montreal General Hospital, McGill University, Montreal, Quebec, Canada.
  1. Address correspondence to: De Q. H. Tran, MD, FRCPC, Department of Anesthesia, Montreal General Hospital, 1650 Cedar Ave, D10-144, Montreal, Quebec, Canada H3G 1A4 (e-mail: de_tran{at}hotmail.com).

Abstract

Background This prospective, randomized, observer-blinded study compared 3 combinations of volume and concentration using the same total dose of lidocaine for ultrasound-guided infraclavicular block.

Methods Ninety patients were randomized to 1 of 3 combinations of volume and concentration for lidocaine: (1) 52.5 mL of lidocaine 1%, (2) 35 mL of lidocaine 1.5%, and (3) 26.25 mL of lidocaine 2%. In all 3 groups, the total dose administered (525 mg) was the same. In addition, epinephrine 5 fg/mL was used in all subjects. The main outcome variable was onset time. The performance time, number of needle passes, block-related pain scores, success rate (surgical anesthesia), and the incidence of vascular puncture and paresthesia were also recorded. The total anesthesia-related time was defined as the sum of the performance and onset times.

Results The onset times, which were 18.8 ± 5.6 minutes (95% confidence interval [CI], 16.4–21.1 minutes), 20.7 ± 7.0 minutes (95% CI, 18.0–23.5 minutes), and 21.7 ± 6.0 minutes (95% CI, 19.1–24.2 minutes) for the 1%, 1.5%, and 2% groups, respectively, were not statistically different.

Furthermore, the performance times (4.4–4.7 minutes), total anesthesia-related times (23.7–26.3 minutes), and rates of surgical anesthesia (90.0%–96.7%) were comparable among the 3 groups. The number of needle passes and procedural discomfort, as well as the incidence of paresthesia and vascular puncture, were also similar. There were minor differences in the patterns of block for individual nerves. In terms of sensory block, compared with the 2% group, more patients in the 1.5% group displayed a complete block of the ulnar and radial nerves at 10 and 20 minutes, respectively. In terms of motor block, the 2% group yielded the lowest of rate of complete block of the musculocutaneous nerve from 15 minutes onward.

Conclusions Using an identical dose (525 mg) of adrenalized lidocaine for ultrasound-guided infraclavicular block, we found no differences in onset time among 3 commonly used concentrations (1%, 1.5%, and 2%). Further studies are required to determine the optimal combination of volume and concentration of lidocaine for other ultrasound-guided approaches to the brachial plexus.

Statistics from Altmetric.com

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

Footnotes

  • Drs González and Bernucci contributed equally to the study.

    None of the authors received funding for this study.

    The authors declare no conflict of interest.