Minimum effective volume of mepivacaine for ultrasound-guided supraclavicular block

BACKGROUND: The aim of this study was to estimate the minimum effective volume (MEV) of 1.5% mepivacaine for ultrasound-guided supraclavicular block by placing the needle near the lower trunk of brachial plexus and multiple injections. METHODS: Thirty patients undergoing forearm and hand surgery received ultrasound-guided supraclavicular block with 1.5% mepivacaine. The initial volume of local anesthetic injected was 24 ml, and local anesthetic volume for the next patient was determined by the response of the previous patient. The next patient received a 3 ml higher volume in the case of the failure of the previous case. If the previous block was successful, the next volume was 3 ml lower. MEV was estimated by the Dixon and Massey up and down method. MEV in 95, 90, and 50% of patients (MEV(95), MEV(90), and MEV(50)) were calculated using probit transformation and logistic regression. RESULTS: MEV(95) of 1.5% mepivacaine was 17 ml (95% confidence interval [CI], 13-42 ml), MEV(90) was 15 ml (95% CI, 12-34 ml), and MEV(50) was 9 ml (95% CI, 4-12 ml). Twelve patients had a failed block. Three patients received general anesthesia. Nine patients could undergo surgery with sedation only. Only one patient showed hemi-diaphragmatic paresis. CONCLUSIONS: MEV(95) was 17 ml, MEV(90) was 15 ml, and MEV(50) was 9 ml. However, needle location near the lower trunk of brachial plexus and multiple injections should be performed.