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Determination of ED50 and ED95 of 0.5% Ropivacaine in Adductor Canal Block to Produce Quadriceps Weakness: A Dose-Finding Study

Johnston, David F. FRCA*; Sondekoppam, Rakesh V. MD; Giffin, Robert FRCSC; Litchfield, Robert FRCSC; Ganapathy, Sugantha FRCPC§

Regional Anesthesia and Pain Medicine: November/December 2017 - Volume 42 - Issue 6 - p 731–736
doi: 10.1097/AAP.0000000000000638
Regional Anesthesia and Acute Pain: Original Articles

Background and Objectives Adductor canal block (ACB) is popular for knee analgesia because of its favorable effect on quadriceps strength. The aim of this study was to find the minimum volume of local anesthetic, which can be injected into the ACB that would result in quadriceps weakness.

Methods This nonrandomized study used an up-and-down sequential allocation design. Twenty-six patients scheduled to undergo arthroscopic knee surgery received an ultrasound-guided ACB preoperatively. The initial volume of ropivacaine 0.5% injected was 30 mL, which was subsequently increased or decreased by 2 mL, depending on whether the previous subject had a 30% reduction in quadriceps function. The minimum effective volume in 50% of patients was determined using Dixon-Massey up-and-down method. The effective volume in 95% of patients was then calculated using probit transformation.

Results The ED50 (minimum effective anesthetic volume in 50% of the subjects) needed for a 30% decrease in quadriceps power was 46.5 mL (95% confidence interval, 45.01–50.43 mL), and estimated ED95 (minimum effective anesthetic volume in 95% of the subjects) was 50.32 mL (95% confidence interval, 48.66–67.26 mL). The local anesthetic volume injected correlated with degree of quadriceps weakness at 20 minutes postblock (P < 0.001) and in the postanesthesia recovery unit (P = 0.032).

Conclusions Significant quadriceps weakness is unlikely when clinically representative volumes of 0.5% ropivacaine is used for ACB performed using sonographic landmarks.

Clinical Trial Registration This study was registered at, identifier NCT02541552.

From the *Department of Anaesthesia, Royal Victoria Hospital, Belfast, Northern Ireland; †Department of Anesthesia and Pain Medicine, University of Alberta, Edmonton, Alberta; and Departments of ‡Orthopedic Surgery, and §Anesthesia and Perioperative Medicine, London Health Sciences Centre, Western University, London, Ontario, Canada.

Accepted for publication March 12, 2017.

Address correspondence to: Rakesh V. Sondekoppam, MD, Department of Anesthesia and Pain Medicine, 2-150 Clinical Sciences Bldg, 8440 112 St NW, University of Alberta, Edmonton, Alberta, Canada T6G 2G3 (e-mail:

The authors declare no conflict of interest.

No external funding grants were required for the study.

Copyright © 2017 by American Society of Regional Anesthesia and Pain Medicine.