The Ropivacaine Concentration Required for Ultrasound-Guided Rectus Sheath Block in Pediatric Patients Undergoing Single-Incision Laparoscopic Hernia Repair: A Sequential Allocation Dose-Finding Study.
effective concentration
pediatric patient
ropivacaine
single-incision laparoscopic hernia repair
ultrasound-guided rectus sheath block
Journal
Cureus
ISSN: 2168-8184
Titre abrégé: Cureus
Pays: United States
ID NLM: 101596737
Informations de publication
Date de publication:
Jun 2023
Jun 2023
Historique:
accepted:
19
06
2023
medline:
24
7
2023
pubmed:
24
7
2023
entrez:
24
7
2023
Statut:
epublish
Résumé
The local anesthetic concentration required for ultrasound-guided rectus sheath block (RSB) in children remains unknown. Knowledge of appropriate ropivacaine concentration can help clinicians reduce local anesthetic toxicity risk when performing ultrasound-guided RSB in children. This study aimed to determine the appropriate ropivacaine concentration for ultrasound-guided RSB in children undergoing laparoscopic inguinal hernia repair. In this single-arm prospective study with an up-down sequential allocation design of binary response variables, 18 consecutive children aged 11 months to 7 years undergoing single-incision laparoscopic percutaneous extraperitoneal closure were assessed. Orotracheal intubation was performed without intravenous anesthesia or a neuromuscular relaxant. After intubation, ultrasound-guided RSB was performed with a ropivacaine dose of 0.30 ml/kg (0.15 ml/kg per side). Dixon's up-and-down method was used to determine the concentration, starting from 0.25% in 0.05% increments. Surgery commenced ≥15 min following RSB. Body movement or a 20% increase in heart rate or systolic blood pressure within 1 min of surgery initiation determined an unsuccessful RSB. The 95% effective concentration of ropivacaine needed for successful RSB was calculated using the probit test. The 95% effective concentration of ropivacaine needed for successful ultrasound-guided RSB was 0.31% (95% confidence interval, 0.25-7.29). The highest concentration of ropivacaine required for successful ultrasound-guided RSB in the group of patients in this study was 0.3%. The 95% effective concentration of ropivacaine (0.30 ml/kg total, 0.15 ml/kg per side) for ultrasound-guided RSB was 0.31% in children undergoing single-incision laparoscopic surgery under general anesthesia.
Sections du résumé
BACKGROUND
BACKGROUND
The local anesthetic concentration required for ultrasound-guided rectus sheath block (RSB) in children remains unknown. Knowledge of appropriate ropivacaine concentration can help clinicians reduce local anesthetic toxicity risk when performing ultrasound-guided RSB in children. This study aimed to determine the appropriate ropivacaine concentration for ultrasound-guided RSB in children undergoing laparoscopic inguinal hernia repair.
METHODS
METHODS
In this single-arm prospective study with an up-down sequential allocation design of binary response variables, 18 consecutive children aged 11 months to 7 years undergoing single-incision laparoscopic percutaneous extraperitoneal closure were assessed. Orotracheal intubation was performed without intravenous anesthesia or a neuromuscular relaxant. After intubation, ultrasound-guided RSB was performed with a ropivacaine dose of 0.30 ml/kg (0.15 ml/kg per side). Dixon's up-and-down method was used to determine the concentration, starting from 0.25% in 0.05% increments. Surgery commenced ≥15 min following RSB. Body movement or a 20% increase in heart rate or systolic blood pressure within 1 min of surgery initiation determined an unsuccessful RSB. The 95% effective concentration of ropivacaine needed for successful RSB was calculated using the probit test.
RESULTS
RESULTS
The 95% effective concentration of ropivacaine needed for successful ultrasound-guided RSB was 0.31% (95% confidence interval, 0.25-7.29). The highest concentration of ropivacaine required for successful ultrasound-guided RSB in the group of patients in this study was 0.3%.
CONCLUSION
CONCLUSIONS
The 95% effective concentration of ropivacaine (0.30 ml/kg total, 0.15 ml/kg per side) for ultrasound-guided RSB was 0.31% in children undergoing single-incision laparoscopic surgery under general anesthesia.
Identifiants
pubmed: 37485192
doi: 10.7759/cureus.40668
pmc: PMC10356968
doi:
Types de publication
Journal Article
Langues
eng
Pagination
e40668Informations de copyright
Copyright © 2023, Tachi et al.
Déclaration de conflit d'intérêts
The authors have declared that no competing interests exist.
Références
Int J Surg. 2016 May;29:25-35
pubmed: 26975426
World J Surg. 2021 Dec;45(12):3609-3615
pubmed: 34458938
Pediatrics. 2009 Jan;123(1):332-7
pubmed: 19117900
Paediatr Anaesth. 2017 May;27(5):516-523
pubmed: 28198572
Anesthesiology. 1994 Jan;80(1):93-6
pubmed: 8291735
Anesth Analg. 2012 Jan;114(1):230-2
pubmed: 22184611
Br J Anaesth. 2006 Aug;97(2):244-9
pubmed: 16798774
Reg Anesth Pain Med. 2009 May-Jun;34(3):247-50
pubmed: 19587624
Paediatr Anaesth. 2014 Sep;24(9):968-73
pubmed: 24853314
JAMA Surg. 2013 Aug;148(8):707-13
pubmed: 23760519
Br J Anaesth. 2011 Nov;107(5):790-5
pubmed: 21856778
Reg Anesth Pain Med. 2016 Jul-Aug;41(4):549-50
pubmed: 27315186
Paediatr Anaesth. 1996;6(6):463-6
pubmed: 8936544
J Pediatr Surg. 2010 Dec;45(12):2386-9
pubmed: 21129551
J Am Assoc Gynecol Laparosc. 2004 Nov;11(4):448
pubmed: 15701183
Anesth Analg. 2016 Jul;123(1):175-8
pubmed: 27314694
Paediatr Anaesth. 2010 Dec;20(12):1061-9
pubmed: 21199114