Abstract:
BACKGROUND:Involutional changes of peripheral nervous system occur with aging. The aim of the study was to determine the minimum effective volume of local anesthetic required to offer an effective ultrasound-guided supraclavicular brachial plexus block in 50% of middle-aged (< 50 years) and elderly (> 65 years) patients. We hypothesized reduced minimum effective volume of local anesthetic in elderly patients. METHODS:Middle-aged (n = 22) and elderly (n = 22) patients undergoing upper limb surgery received an ultrasound-guided supraclavicular brachial plexus block. Structural analysis of the brachial plexus in supraclavicular region was obtained by measuring the cross-sectional area. The prospective, observer-blinded study method is a previously validated step-up/step-down sequence model where the local anesthetic volume for the next patient is determined by the outcome of the previous block. The starting volume was 30 ml (50 : 50 mixture, 0.5%wt/vol levobupivacaine, 2%wt/vol lidocaine). The minimum effective volume of local anesthetic was determined using Dixon and Masey method. RESULTS:The minimum effective local anesthetic volume significantly differed between middle-aged and elderly [23.0 ml, 95% confidence interval (CI) 13.7-32.3 vs. 11.9 ml, 95% CI 9.3-14.6; 95% CI of the difference 1.6-20.6, P = 0.027]. The cross-sectional area of brachial plexus was 0.95 ± 0.15 in middle-aged and 0.51 ± 0.06 cm(2) in elderly patients (P < 0.001). CONCLUSIONS:Within the present study, we report a reduced minimum effective anesthetic volume for ultrasound-guided supraclavicular block in elderly patients. Additionally, smaller cross-sectional surface area of brachial plexus in the supraclavicular region was observed.
journal_name
Acta Anaesthesiol Scandjournal_title
Acta anaesthesiologica Scandinavicaauthors
Pavičić Šarić J,Vidjak V,Tomulić K,Zenko Jdoi
10.1111/aas.12109subject
Has Abstractpub_date
2013-07-01 00:00:00pages
761-6issue
6eissn
0001-5172issn
1399-6576journal_volume
57pub_type
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