• Alexandre Takeda, Leonardo Henrique Cunha Ferraro, André Hosoi Rezende, Eduardo Jun Sadatsune, Falcão Luiz Fernando dos Reis LF Department of Anesthesiology, Pain and Intensive Care, Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP), São Paul, and Maria Angela Tardelli.
• Department of Anesthesiology, Pain and Intensive Care, Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil.
• Braz J Anesthesiol. 2015 May 1; 65 (3): 163-9.

IntroductionThe use of ultrasound in regional anesthesia allows reducing the dose of local anesthetic used for peripheral nerve block. The present study was performed to determine the minimum effective concentration (MEC90) of bupivacaine for axillary brachial plexus block.MethodsPatients undergoing hand surgery were recruited. To estimate the MEC90, a sequential up-down biased coin method of allocation was used. The bupivacaine dose was 5 mL for each nerve (radial, ulnar, median, and musculocutaneous). The initial concentration was 0.35%. This concentration was changed by 0.05% depending on the previous block; a blockade failure resulted in increased concentration for the next patient; in case of success, the next patient could receive or reduction (0.1 probability) or the same concentration (0.9 probability). Surgical anesthesia was defined as driving force ≤ 2 according to the modified Bromage scale, lack of thermal sensitivity and response to pinprick. Postoperative analgesia was assessed in the recovery room with numeric pain scale and the amount of drugs used within 4h after the blockade.ResultsMEC90 was 0.241% [R(2): 0.978, confidence interval: 0.20-0.34%]. No patient, with successful block, reported pain after 4h.ConclusionThis study demonstrated that ultrasound guided axillary brachial plexus block can be performed with the use of low concentration of local anesthetics, increasing the safety of the procedure. Further studies should be conducted to assess blockade duration at low concentrations.Copyright © 2014 Sociedade Brasileira de Anestesiologia. Published by Elsevier Editora Ltda. All rights reserved.

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