The minimum effective concentration (MEC90) of ropivacaine for ultrasound-guided caudal block in anorectal surgery. A dose finding study

• Published in: PloS one Vol. 16; no. 9; p. e0257283
• Main Authors: Li, Xuehan, Li, Jun, Zhang, Pei, Deng, Huifei, Yang, Mingan, He, Hongbo, Wang, Rurong
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 17.09.2021; Public Library of Science (PLoS)
• Subjects: Adult; Algorithms; Anal Canal - surgery; Analgesics; Anesthesia; Anesthesia, Epidural - methods; Anesthesiology; Anesthetics, Local - administration & dosage; Anorectal; Biology and Life Sciences; Blood pressure; Catheters; Clinical trials; Complications and side effects; Design; Dosage and administration; Dose-Response Relationship, Drug; Drug dosages; Epidural; Female; Hospitals; Humans; Intensive care; Laboratories; Ligaments; Male; Males; Medicine; Medicine and Health Sciences; Microbial Sensitivity Tests; Middle Aged; Narcotics; Operating Rooms; Pain; Patient outcomes; Patients; Perineum; Postoperative Period; Prospective Studies; Rectum - surgery; Research and Analysis Methods; Ropivacaine; Ropivacaine - pharmacology; Social Sciences; Sphincter; Surgery; Ultrasonic imaging; United States; China
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0257283

Caudal epidural block (CEB) provides reliable anesthesia for adults undergoing anorectal surgery. Despite the widely utilization, the minimum effective concentration for 90% patients (MEC90) of ropivacaine for CEB remains unknown. To estimate MEC of ropivacaine for CEB in anorectal surgery. A prospective dose-finding study using biased coin design up-and-down sequential method. Operating room and postoperative recovery area of Chengdu Shangjin Nanfu Hospital, from October 2019 to January 2020. 50 males and 51 females scheduled for anorectal surgery. We conducted two independent biased coin design up-and down trials by genders. The concentration of ropivacaine administered to the first patient of male and female were 0.25% with fixed volume of 14ml for male and 12ml for female patients based on our previous study. In case of failure, the concentration was increased by 0.05% in the next subject. Otherwise, the next subject was randomized to a concentration 0.05% less with a probability of 0.11, or the same concentration with a probability of 0.89. Success was defined as complete sensory blockade of perineal area 15 min after the block evidenced by the presence of a lax anal sphincter and pain-free surgery. The MEC of ropivacaine to achieve a successful CEB in 90%(MEC90) of the patients. The MEC90 of ropivacaine for CEB were estimated to be 0.35% (95% CI 0.29 to 0.4%) for male and 0.353% (95%CI 0.22 to 0.4%) for female. By extrapolation to MEC in 99% of subjects (MEC99) and pooled adjacent violators algorithm (PAVA) adjusted responses, it would be optimal to choose 0.4% ropivacaine with a volume of 14ml for male and 12ml for female. A concentration of 0.35% ropivacaine with a volume of 14ml provided a successful CEB in 90% of the male patients, while 0.353% ropivacaine with a volume of 12ml provided a successful CEB in 90% of the female patients. A concentration of 0.4% and a volume of 14ml for male and 12 ml for female would be successful in 99% of the patients. Chictr.org.cn identifier: No. ChiCTR 1900024315.