The Ropivacaine Concentration Required for Ultrasound-Guided Ilioinguinal/Iliohypogastric Nerve Block in Pediatric Patients

Anesthesia & Analgesia: July 2016 – Volume 123 – Issue 1 – p 175–178

AUTHORS: Yamada, Kumiko MD et al

BACKGROUND: To the best of our knowledge, the ropivacaine concentration required for ultrasound-guided ilioinguinal and iliohypogastric nerve block (INB) has not been reported. We designed this study to examine the 50% effective concentration (EC₅₀) of ropivacaine for ultrasound-guided INB in children anesthetized with 2% sevoflurane.

METHODS: We studied 30 consecutive children (age range, 6 months to 11 years) ASA physical status I to II undergoing unilateral open inguinal hernia repair. General anesthesia was induced by sevoflurane and maintained with 2% end-tidal concentration of sevoflurane in air and oxygen (FIO₂ = 0.4). Ultrasound-guided INB was performed using a 3 mL ropivacaine solution. The first child received 0.3% ropivacaine, and subsequent concentrations were determined by the response of the previous patient to initial skin incision using Dixon up-and-down method. The testing interval was set at 0.1%, and the lowest concentration was 0.05% (0.05%, 0.1%, 0.2%, 0.3%, 0.4%, or 0.5%). The EC₅₀ for INB of ropivacaine was analyzed using probit test.

RESULTS: The concentration at which all patients showed complete block was 0.50%, according to the up-and-down method. The EC₅₀ was 0.21% (95% confidence interval, 0.03–0.34).

CONCLUSIONS: The EC₅₀ of ropivacaine for ultrasound-guided INB was 0.21% (95% confidence interval, 0.03–0.34), in pediatric patients anesthetized with 2% sevoflurane.