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Local Anesthetics: Clinical Application as Spinal Anesthesia

Local Anesthetics: Clinical Application as Spinal Anesthesia

Spinal anesthetics are given during lower abdomen and limb surgeries to block sensory and motor neurons. They are administered in the mid to low lumbar regions, primarily acting on the cauda equina's nerve roots. The blockade level depends on the local anesthetic (LA) concentration. Usually, low LA concentrations are sufficient to block sensory fibers, while only high LA concentrations block motor fibers. Other factors like injection volume and speed, the patient's posture, and the drug...

Local Anesthetics: Clinical Application as Epidural Anesthesia

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Epidural anesthetics are administered in the fat-filled epidural space, the outermost part of the spinal canal. This technique is commonly employed for pain management and anesthesia during lower abdomen and pelvis surgeries or labor and delivery.
Since epidural anesthetics can be infused through an epidural catheter, all types of drugs, including short-acting ones, can be administered. Chloroprocaine and lidocaine are examples of short and long-duration anesthetics, respectively. Bupivacaine...

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The Shamrock lumbar plexus block: A dose-finding study.

Axel R Sauter¹, Kyrre Ullensvang, Geir Niemi

¹From the Division of Emergencies and Critical Care, Department of Anaesthesiology, Oslo University Hospital Rikshospitalet (ARS, KU, GN, LR), Department of Anaesthesiology, Lovisenberg Diakonale Hospital, Oslo, Norway (HTL), Department of Anaesthesia and Intensive Care Medicine, Aarhus University Hospital, Aarhus (TFB), Department of Anaesthesia and Intensive Care Medicine, Roskilde Hospital, University of Copenhagen, Copenhagen, Denmark (JB), and Oslo Centre for Biostatistics and Epidemiology, Research Support Services, Oslo University Hospital, Oslo, Norway (AHP).

European Journal of Anaesthesiology

|October 2, 2015

Summary

This summary is machine-generated.

This study determined the optimal ropivacaine dose for the Shamrock lumbar plexus block. An effective dose of 20.4 mL of 0.5% ropivacaine was found to be sufficient for 50% of patients undergoing lower limb surgery.

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Area of Science:

Anesthesiology
Regional Anesthesia
Ultrasound-Guided Procedures

Background:

The Shamrock technique is an emerging method for ultrasound-guided lumbar plexus blockade.
Optimal local anesthetic dosage for this technique remains undetermined.
ClinicalTrials.gov identifier: NCT01956617.

Purpose of the Study:

To estimate the effective dose of 0.5% ropivacaine for achieving a successful Shamrock lumbar plexus block.
To determine the dose required for 50% (ED50) and 95% (ED95) success rates.
To analyze effective doses for sensory block without motor block.

Main Methods:

Prospective dose-finding study utilizing Dixon's up-and-down sequential method.
Ropivacaine 0.5% was titrated in 5 mL increments.
Thirty patients undergoing lower limb orthopedic surgery were included.

Main Results:

The estimated effective dose for 50% of patients (ED50) was 20.4 mL of 0.5% ropivacaine.
The estimated effective dose for 95% of patients (ED95) was 36.0 mL of 0.5% ropivacaine.
For sensory block only, ED50 was 17.1 mL and ED95 was 25.8 mL.

Conclusions:

A volume of 20.4 mL of 0.5% ropivacaine provides effective Shamrock lumbar plexus block in 50% of patients.
A volume of 36.0 mL of 0.5% ropivacaine is estimated to be successful in 95% of patients.
These findings provide crucial data for optimizing local anesthetic administration in this technique.