Effective local anaesthetic volumes for sciatic nerve blockade: a clinical evaluation of the ED99.

Abstract

Previous results in volunteers have indicated the effective dose in 99% of subjects (ED99 ) of local anaesthetic volume to be 0.10 ml.mm(-2) of cross-sectional nerve area for sciatic nerve blockade. The objective of this prospective, randomised, double-blind study was to investigate the ED99 of local anaesthetic for ultrasound-guided sciatic nerve blockade in patients undergoing foot surgery, according to Dixon's up-and-down method and probit analysis. A starting volume of 0.20 ml local anaesthetic per mm(2) cross-sectional nerve area was used. If surgical anaesthesia was judged to be adequate, the volume of local anaesthetic for the next case was reduced by 0.02 ml.mm(-2), until the first block failed. Thereafter, the volume of local anaesthetic was increased by 0.02 ml.mm(-2). The ED99 volume of local anaesthetic for ultrasound-guided sciatic nerve blockade was calculated to be 0.15 ml.mm(-2) cross-sectional nerve area, which is higher than the previously evaluated ED99 volume in volunteers.