title: Minimum effective volume of mepivacaine for ultrasound-guided supraclavicular block.
abstract: 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 (MEV95, MEV90, and MEV50) were calculated using probit transformation and logistic regression.
  
  
  RESULTS
  MEV95 of 1.5% mepivacaine was 17 ml (95% confidence interval [CI], 13-42 ml), MEV90 was 15 ml (95% CI, 12-34 ml), and MEV50 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
  MEV95 was 17 ml, MEV90 was 15 ml, and MEV50 was 9 ml. However, needle location near the lower trunk of brachial plexus and multiple injections should be performed.
authors.affiliation: Department of Anesthesiology and Pain Medicine, College of Medicine, Dankook University, Cheonan, Korea.
authors.forename: Jae Gyok
authors.initials: JG
authors.lastname: Song
authors.forename: Dae Geun
authors.initials: DG
authors.lastname: Jeon
authors.forename: Bong Jin
authors.initials: BJ
authors.lastname: Kang
authors.forename: Kee Keun
authors.initials: KK
authors.lastname: Park
keywords: Mepivacaine; Minimum effective volume; Supraclavicular block; Ultrasound
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