title: [Minimum effective concentration of bupivacaine for axillary brachial plexus block guided by ultrasound].
abstract: BACKGROUND
  The use of ultrasound in regional anesthesia allows reducing the dose of local anesthetic used for peripheral nerve block. The present study was performed to determine the minimum effective concentration (MEC90) of bupivacaine for axillary brachial plexus block (ABPB).
  
  
  METHODS
  Patients undergoing hand surgery were recruited. To estimate the MEC90, a sequential up-down biased coin method of allocation was used. The bupivacaine dose was 5mL for each nerve (radial, ulnar, median, and musculocutaneous). The initial concentration was 0.35%. This concentration was changed by 0.05% depending on the previous block: a blockade failure resulted in increased concentration for the next patient; in case of success, the next patient could receive or reduction (0.1 probability) or the same concentration (0.9 probability). Surgical anesthesia was defined as driving force ≤ 2 according to the modified Bromage scale, lack of thermal sensitivity and response to pinprick. Postoperative analgesia was assessed in the recovery room with numeric pain scale and the amount of drugs used within 4hours after the blockade.
  
  
  RESULTS
  MEC90 was 0.241% [R2: 0.978, confidence interval: 0.20%-0.34%]. No successful block patient reported pain after 4hours.
  
  
  CONCLUSIONS
  This study demonstrated that ultrasound guided ABPB can be performed with the use of low concentration of local anesthetics, increasing the safety of the procedure. Further studies should be conducted to assess blockade duration at low concentrations.
authors.affiliation: Disciplina de Anestesiologia, Dor e Terapia Intensiva, Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brasil.
authors.forename: Alexandre
authors.initials: A
authors.lastname: Takeda
authors.affiliation: Disciplina de Anestesiologia, Dor e Terapia Intensiva, Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brasil. Electronic address: leohcferraro@yahoo.com.br.
authors.forename: Leonardo Henrique Cunha
authors.initials: LH
authors.lastname: Ferraro
authors.affiliation: Disciplina de Anestesiologia, Dor e Terapia Intensiva, Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brasil.
authors.forename: André Hosoi
authors.initials: AH
authors.lastname: Rezende
authors.affiliation: Disciplina de Anestesiologia, Dor e Terapia Intensiva, Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brasil.
authors.forename: Eduardo Jun
authors.initials: EJ
authors.lastname: Sadatsune
authors.affiliation: Disciplina de Anestesiologia, Dor e Terapia Intensiva, Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brasil.
authors.forename: Luiz Fernando Dos Reis
authors.initials: LF
authors.lastname: Falcão
authors.affiliation: Disciplina de Anestesiologia, Dor e Terapia Intensiva, Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brasil.
authors.forename: Maria Angela
authors.initials: MA
authors.lastname: Tardelli
keywords: Anestesia regional; Axillary block; Bloqueio axilar; Bloqueio do plexo braquial; Brachial plexus block; Bupivacaina; Bupivacaine; Concentração mínima efetiva; Minimum effective concentration; Regional anesthesia; Ultrasound; Ultrassom