Evidence map›Paper›PMID 40739616›Full record

Trial reportBMC anesthesiology2025

Maximum effective volume of 0.25% ropivacaine for preventing hemidiaphragmatic paralysis in 90% of patients undergoing shoulder arthroscopy: a biased coin up-and-down sequential allocation trial for ultrasound-guided superior trunk block.

Kai Wang, Hongwei Zhu, Yangyang Zhou, Shukai Gui, Yonghua Li

Abstract readRandomized Controlled Trial
PubMed Full text at PMC Publisher
In one paragraph

Trial report in BMC anesthesiology, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 5 papers.

0numbers the graph read from it
0cells of the map it votes in
5citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

5 citing papers in PubMed.

  1. Trial
  2. Review
  3. Article
  4. Review
  5. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

5 authors.

Kai Wang *Department of Anesthesiology, Second Affiliated Hospital, Changzheng Hospital, Naval Medical University, Shanghai, China.
Hongwei Zhu *Department of Anesthesiology, Second Affiliated Hospital, Changzheng Hospital, Naval Medical University, Shanghai, China.
Yangyang Zhou *Department of Anesthesiology, Second Affiliated Hospital, Changzheng Hospital, Naval Medical University, Shanghai, China.
Shukai GuiDepartment of Anesthesiology, Second Affiliated Hospital, Changzheng Hospital, Naval Medical University, Shanghai, China.
Yonghua LiDepartment of Anesthesiology, Second Affiliated Hospital, Changzheng Hospital, Naval Medical University, Shanghai, China. liyonghua1207@smmu.edu.cn.

Funding

Medical Innovation Research Projects of Shanghai Science and Technology Commission 22Y11904000
6 · The paper itself

Abstract

backgroundCompared to interscalene block (ISB), the superior trunk block (STB) lowers the incidence of hemidiaphragmatic paralysis (HDP) without compromising analgesic efficacy, making it a valuable alternative. However, the lack of consensus on the optimal local anesthetic (LA) dose for STB limits its standardized clinical application. This study employed a dose-finding protocol to determine the maximum effective volume of 0.25% ropivacaine required to prevent HDP in 90% of patients (MEV90) undergoing shoulder arthroscopy with ultrasound-guided STB.

methodsA biased coin design was used for volume assignment. All patients except the first one received a LA volume determined by the response observed in the immediately preceding participant. In case of "failure" (defined as the presence of HDP after STB), the subsequent patient received a lower volume (2 mL less than the previous dose). In case of "success" (absence of HDP), subsequent patients were randomly allocated to received either: (1) an increased volume (2 ml higher than the previous dose) with an 11% probability, or (2) the same volume with an 89% probability.

resultsThe study cohort comprised 52 patients indicated for shoulder arthroscopy finally. Using isotonic regression with bootstrapped confidence intervals (CIs), the MEV90 of 0.25% ropivacaine for ultrasound-guided STB was estimated at 7.6 mL (95% CI: 6.5-8.5 mL).

conclusionsThe MEV90 of 0.25% ropivacaine for ultrasound-guided superior trunk block to prevent hemidiaphragmatic paralysis was 7.6 mL.

trial registrationChinese Clinical Trial Registry (ChiCTR2200059042); first registered 23/04/2022.

Indexed as

Anesthetics, LocalArthroscopyNerve BlockRespiratory ParalysisRopivacaineUltrasonography, InterventionalAdultDose-Response Relationship, DrugFemaleHumansMaleMiddle AgedShoulderAnesthetics, LocalRopivacaineBiased coin up-and-down methodHemidiaphragmatic paralysisShoulder arthroscopySuperior trunk block

Identifiers

PMID40739616
PMCPMC12312237

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.