Minimum effective concentration of ropivacaine for ultrasound-guided transmuscular quadratus lumborum block in total hip arthroplasty: a randomized clinical trial
Concentração mínima efetiva de ropivacaína para bloqueio transmuscular do quadrado lombar guiado por ultrassom em artroplastia total de quadril: ensaio clínico randomizado
Jian Hu, Xingcheng Li, Qiuru Wang, Jing Yang
Abstract
Objective
This trial aimed to identify the Minimum Effective Concentration (MEC90, defined as the concentration which can provide successful block in 90% of patients) of 30 mL ropivacaine for single-shot ultrasound-guided transmuscular Quadratus Lumborum Block (QLB) in patients undergoing Total Hip Arthroplasty (THA).
Methods
A double-blind, randomized dose-finding study using the biased coin design up-and-down sequential method, where the concentration of local anesthetic administered to each patient depended on the response from the previous one. Block success was defined as a Numeric Rating Scale (NRS) score during motion ≤ 3 at 6 hours after arrival in the ward. If the block was successful, the next subject received either a 0.025% smaller dose (probability of 0.11) or the same dose (probability of 0.89); otherwise, the next subject received a 0.025% higher ropivacaine concentration. MEC90, MEC95 and MEC99 were estimated by isotonic regression, and the corresponding 95% Confidence Intervals (95% CIs) were calculated by the bootstrapping method.
Results
Based on the analysis of 52 patients, MEC90, MEC95, and MEC99 of ropivacaine for QLB were estimated to be 0.352% (95% CI 0.334–0.372%), 0.363% (95% CI 0.351–0.383%), and 0.373% (95% CI 0.363–0.386%). The concentration of ropivacaine at 0.352% in a volume of 30 ml can provide a successful block in 90% of patients.
Conclusions
For ultrasound-guided transmuscular QLB in patients undergoing THA, 0.352% ropivacaine in a volume of 30 ml can provide a successful block in 90% of patients. Further dose-finding studies and large sample size are required to verify the concentration.
Keywords
Resumo
Introdução
Este estudo teve como objetivo identificar a concentração mínima eficaz (MEC90, definida como a concentração que pode fornecer bloqueio bem-sucedido em 90% dos pacientes) de 30 mL de ropivacaína para bloqueio transmuscular do quadrado lombar (BQL) guiado por ultrassom de dose única em pacientes submetidos a cirurgia de artroplastia total de quadril (ATQ).
Métodos
Estudo duplo-cego, randomizado de determinação de dose usando o método sequencial up-and-down de desenho de moeda tendenciosa, onde a concentração de anestésico local administrado a cada paciente dependia da resposta do anterior. O sucesso do bloqueio foi definido como uma pontuação na Escala de Avaliação Numérica (NRS) durante o movimento ≤ 3, 6 horas após a chegada à enfermaria. Se o bloqueio fosse bem-sucedido, o próximo sujeito recebia uma dose 0,025% menor (probabilidade de 0,11) ou a mesma dose (probabilidade de 0,89); caso contrário, o próximo sujeito recebeu uma concentração de ropivacaína 0,025% maior. MEC90, MEC95 e MEC99 foram estimados por regressão isotônica, e os correspondentes intervalos de confiança de 95% (IC95%) foram calculados pelo método de bootstrapping.
Resultados
Com base na análise de 52 pacientes, MEC90, MEC95 e MEC99 de ropivacaína para BQL foram estimados em 0,352% (IC 95% 0,334–0,372%), 0,363% (IC 95% 0,351–0,383%) e 0,373% ( IC 95% 0,363–0,386%). A concentração de ropivacaína a 0,352% em um volume de 30 ml pode proporcionar bloqueio bem-sucedido em 90% dos pacientes.
Conclusão
Para BQL transmuscular guiado por ultrassom em pacientes submetidos à ATQ, a ropivacaína a 0,352% em um volume de 30 ml pode proporcionar um bloqueio bem-sucedido em 90% dos pacientes. Mais estudos de determinação de dose e um grande tamanho de amostra são necessários para verificar a concentração.
Palavras-chave
References
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Submitted date:
12/02/2022
Accepted date:
08/20/2023
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