Background and Objectives: The aim of this study was to determine the minimum effective volume (MEV) of combined lidocaine 1.0%–bupivacaine 0.25% with epinephrine 5 μg/mL in 90% of patients (MEV90) for ultrasound-guided subparaneural popliteal sciatic nerve block.
Methods: All subjects received an ultrasound-guided subparaneural popliteal sciatic nerve block (at the neural bifurcation) with combined lidocaine 1.0%–bupivacaine 0.25% and epinephrine 5 μg/mL. Using an out-of-plane technique, a 17-gauge, 8-cm Tuohy needle was advanced until its tip was positioned between the tibial and peroneal nerves inside the paraneural sheath. Volume assignment was carried out using a biased coin design, up-and-down sequential method, where the volume of local anesthetic administered to each patient depended on the response of the previous one. In case of failure, the next subject received a higher volume (defined as the previous volume with an increment of 3.0 mL). If the previous patient had a successful block, the next subject was randomized to a lower volume (defined as the previous volume with a decrement of 3.0 mL), with a probability of b = 0.11, or the same volume, with a probability of 1 – b = 0.89. Using a composite scale encompassing sensory and motor block, success was defined, at 30 minutes, as a minimal score of 6 points (out of 8 points). The 6-point score was intended to mirror successful postoperative analgesia. Patients undergoing surgery of the leg, ankle, or foot were prospectively enrolled until 45 successful blocks were obtained.
Results: Fifty-two patients were recruited for this study. Using isotonic regression and bootstrap confidence interval, the MEV90 of combined lidocaine 1.0%–bupivacaine 0.25% with epinephrine 5 μg/mL was estimated to be 13.3 mL (95% confidence interval, 10.2–16.4 mL).
Conclusions: For ultrasound-guided subparaneural (analgesic) popliteal sciatic nerve block, the MEV90 of combined lidocaine 1.0%–bupivacaine 0.25% with epinephrine 5 μg/mL is 13.3 mL (95% confidence interval, 10.2–16.4 mL).
From the *Montreal General Hospital, Department of Anesthesia, McGill University, Montreal, Quebec, Canada; †Hospital de Carabineros, Department of Anesthesia, Santiago, Chile; and ‡Department of Mathematics and Statistics, McGill University, Montreal, Quebec, Canada.
Accepted for publication December 4, 2013.
Address correspondence to: De Q.H. Tran, MD, FRCPC, Montreal General Hospital, Department of Anesthesia 1650 Ave Cedar, D10-144, Montreal, Quebec, Canada H3G 1A4 (e-mail: email@example.com).
The authors declare no conflict of interest.
None of the authors received funding for this study.