Cargando…

Study on MEV90 of 0.5% ropivacaine for US-guided caudal epidural block in anorectal surgery

BACKGROUND: Choosing the appropriate concentration and volume of anesthetics is critical for a successful nerve block. The current study aimed to determine the minimum effective volume (MEV) of 0.5% ropivacaine for US-guided CEB in 90% of patients (MEV90) undergoing anorectal surgery. The aims were...

Descripción completa

Detalles Bibliográficos
Autores principales: Zhang, Pei, Chang, Hong, Yang, Taoran, Fu, Yalong, He, Xuemei, Li, Jun, Yang, Mingan, Wang, Rurong, Li, Xuehan
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9892538/
https://www.ncbi.nlm.nih.gov/pubmed/36743672
http://dx.doi.org/10.3389/fmed.2022.1077478
_version_ 1784881344215515136
author Zhang, Pei
Chang, Hong
Yang, Taoran
Fu, Yalong
He, Xuemei
Li, Jun
Yang, Mingan
Wang, Rurong
Li, Xuehan
author_facet Zhang, Pei
Chang, Hong
Yang, Taoran
Fu, Yalong
He, Xuemei
Li, Jun
Yang, Mingan
Wang, Rurong
Li, Xuehan
author_sort Zhang, Pei
collection PubMed
description BACKGROUND: Choosing the appropriate concentration and volume of anesthetics is critical for a successful nerve block. The current study aimed to determine the minimum effective volume (MEV) of 0.5% ropivacaine for US-guided CEB in 90% of patients (MEV90) undergoing anorectal surgery. The aims were to reduce the occurrence of complications associated with a sacral blockade in anorectal surgery, broaden the indications for surgical procedures and treatment, and improve patient satisfaction. This study presents the groundwork for the development of individualized anesthetic programs. We believe that the study would serve as a reference for the use of caudal epidural block (CEB) in lower abdominal surgery for intraoperative and postoperative analgesia. METHODS: This study used a biased coin design (BCD) up-and-down method (UDM). We divided the participants into two groups based on gender, and each group independently performed the biased coin design up-and-down method. We used 0.5% ropivacaine for the first patient in each group; however, the volume was 10 ml for men and 8 ml for women. Therefore, the dose of anesthetics given to each patient was determined by the response of the previous patient. If the block of the previous patient failed, the volume was increased by 2 ml in the following patient. Otherwise, the next subject had an 11% chance of receiving a volume of 2 ml less or an 89% chance of receiving no volume change. We defined a successful block as painless surgery with anal sphincter relaxation 15 min after the drug injection. Enrollment was completed after 45 successful caudal blocks for each group. RESULTS: Caudal epidural block was successfully performed on 50 men and 49 women. The MEV90 of ropivacaine for CEB was calculated to be 12.88 ml (95% CI: 10.8–14 ml) for men and 10.73 ml (95% CI: 9.67–12 ml) for women. Men had a MEV99 of 13.88 ml (95% CI: 12.97–14 ml), and women had a MEV99 of 11.87 ml (95% CI: 11.72–12 ml). CONCLUSION: With operability and general applicability, it is possible to increase the success rate of CEB for anorectal surgery to 99% as well as decrease the incidence of anesthesia-related complications. CEB can meet the needs of patients for rapid postoperative rehabilitation, improve patient satisfaction, and lay a solid foundation for postoperative analgesia.
format Online
Article
Text
id pubmed-9892538
institution National Center for Biotechnology Information
language English
publishDate 2023
publisher Frontiers Media S.A.
record_format MEDLINE/PubMed
spelling pubmed-98925382023-02-03 Study on MEV90 of 0.5% ropivacaine for US-guided caudal epidural block in anorectal surgery Zhang, Pei Chang, Hong Yang, Taoran Fu, Yalong He, Xuemei Li, Jun Yang, Mingan Wang, Rurong Li, Xuehan Front Med (Lausanne) Medicine BACKGROUND: Choosing the appropriate concentration and volume of anesthetics is critical for a successful nerve block. The current study aimed to determine the minimum effective volume (MEV) of 0.5% ropivacaine for US-guided CEB in 90% of patients (MEV90) undergoing anorectal surgery. The aims were to reduce the occurrence of complications associated with a sacral blockade in anorectal surgery, broaden the indications for surgical procedures and treatment, and improve patient satisfaction. This study presents the groundwork for the development of individualized anesthetic programs. We believe that the study would serve as a reference for the use of caudal epidural block (CEB) in lower abdominal surgery for intraoperative and postoperative analgesia. METHODS: This study used a biased coin design (BCD) up-and-down method (UDM). We divided the participants into two groups based on gender, and each group independently performed the biased coin design up-and-down method. We used 0.5% ropivacaine for the first patient in each group; however, the volume was 10 ml for men and 8 ml for women. Therefore, the dose of anesthetics given to each patient was determined by the response of the previous patient. If the block of the previous patient failed, the volume was increased by 2 ml in the following patient. Otherwise, the next subject had an 11% chance of receiving a volume of 2 ml less or an 89% chance of receiving no volume change. We defined a successful block as painless surgery with anal sphincter relaxation 15 min after the drug injection. Enrollment was completed after 45 successful caudal blocks for each group. RESULTS: Caudal epidural block was successfully performed on 50 men and 49 women. The MEV90 of ropivacaine for CEB was calculated to be 12.88 ml (95% CI: 10.8–14 ml) for men and 10.73 ml (95% CI: 9.67–12 ml) for women. Men had a MEV99 of 13.88 ml (95% CI: 12.97–14 ml), and women had a MEV99 of 11.87 ml (95% CI: 11.72–12 ml). CONCLUSION: With operability and general applicability, it is possible to increase the success rate of CEB for anorectal surgery to 99% as well as decrease the incidence of anesthesia-related complications. CEB can meet the needs of patients for rapid postoperative rehabilitation, improve patient satisfaction, and lay a solid foundation for postoperative analgesia. Frontiers Media S.A. 2023-01-19 /pmc/articles/PMC9892538/ /pubmed/36743672 http://dx.doi.org/10.3389/fmed.2022.1077478 Text en Copyright © 2023 Zhang, Chang, Yang, Fu, He, Li, Yang, Wang and Li. https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Medicine
Zhang, Pei
Chang, Hong
Yang, Taoran
Fu, Yalong
He, Xuemei
Li, Jun
Yang, Mingan
Wang, Rurong
Li, Xuehan
Study on MEV90 of 0.5% ropivacaine for US-guided caudal epidural block in anorectal surgery
title Study on MEV90 of 0.5% ropivacaine for US-guided caudal epidural block in anorectal surgery
title_full Study on MEV90 of 0.5% ropivacaine for US-guided caudal epidural block in anorectal surgery
title_fullStr Study on MEV90 of 0.5% ropivacaine for US-guided caudal epidural block in anorectal surgery
title_full_unstemmed Study on MEV90 of 0.5% ropivacaine for US-guided caudal epidural block in anorectal surgery
title_short Study on MEV90 of 0.5% ropivacaine for US-guided caudal epidural block in anorectal surgery
title_sort study on mev90 of 0.5% ropivacaine for us-guided caudal epidural block in anorectal surgery
topic Medicine
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9892538/
https://www.ncbi.nlm.nih.gov/pubmed/36743672
http://dx.doi.org/10.3389/fmed.2022.1077478
work_keys_str_mv AT zhangpei studyonmev90of05ropivacaineforusguidedcaudalepiduralblockinanorectalsurgery
AT changhong studyonmev90of05ropivacaineforusguidedcaudalepiduralblockinanorectalsurgery
AT yangtaoran studyonmev90of05ropivacaineforusguidedcaudalepiduralblockinanorectalsurgery
AT fuyalong studyonmev90of05ropivacaineforusguidedcaudalepiduralblockinanorectalsurgery
AT hexuemei studyonmev90of05ropivacaineforusguidedcaudalepiduralblockinanorectalsurgery
AT lijun studyonmev90of05ropivacaineforusguidedcaudalepiduralblockinanorectalsurgery
AT yangmingan studyonmev90of05ropivacaineforusguidedcaudalepiduralblockinanorectalsurgery
AT wangrurong studyonmev90of05ropivacaineforusguidedcaudalepiduralblockinanorectalsurgery
AT lixuehan studyonmev90of05ropivacaineforusguidedcaudalepiduralblockinanorectalsurgery