Optimal volume of local anaesthetic for adductor canal block: using the continual reassessment method to estimate ED95 P. Jæger, M.T. Jenstrup, J. Lund,

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Optimal volume of local anaesthetic for adductor canal block: using the continual reassessment method to estimate ED95 P. Jæger, M.T. Jenstrup, J. Lund, V. Siersma, V. Brøndum, K.L. Hilsted, J.B. Dahl British Journal of Anaesthesia Volume 115, Issue 6, Pages 920-926 (December 2015) DOI: 10.1093/bja/aev362 Copyright © 2015 The Author(s) Terms and Conditions

Fig 1 Schematic representation of subjects’ flow through the trial and the continual reassessment method applied. MRI, magnetic resonance imaging. British Journal of Anaesthesia 2015 115, 920-926DOI: (10.1093/bja/aev362) Copyright © 2015 The Author(s) Terms and Conditions

Fig 2 Schematic representation of the series of successful and non-successful blocks. In total, 34 out of 40 blocks were successful in ensuring distal filling of the adductor canal. British Journal of Anaesthesia 2015 115, 920-926DOI: (10.1093/bja/aev362) Copyright © 2015 The Author(s) Terms and Conditions

Fig 3 Posterior probability for distal filling of the adductor canal as assessed by magnetic resonance imaging. After 40 blocks had been performed, the dose closest to the targeted 95% response probability (ED95) was the 20 ml dose, with an estimated success probability of 95.1% (95% credibility interval: 91–98%). Posterior probability quantiles: 2.5, 25, 50, 75, and 97.5%. Diamond shows estimated ED95. Of note, because of the high success rate encountered with the 20 ml dose, the CRM never recommended higher doses. Hence, the 25 and 30 ml doses were never tested, and the posterior probabilities estimated for these doses are therefore based on the prior probabilities and an extrapolation of the results from the lower doses using the dose–response model. British Journal of Anaesthesia 2015 115, 920-926DOI: (10.1093/bja/aev362) Copyright © 2015 The Author(s) Terms and Conditions

Fig 4 Quadriceps muscle strength at different doses. Muscle strength was assessed as maximal voluntary isometric contraction (MVIC) and is presented as a percentage of the baseline value. Data are expressed as median (horizontal bar) with 25th–75th (box) and 10th–90th percentiles (error bars). British Journal of Anaesthesia 2015 115, 920-926DOI: (10.1093/bja/aev362) Copyright © 2015 The Author(s) Terms and Conditions

Fig 5 Magnetic resonance image showing the spread of local anaesthetic in the adductor canal. (a) Cross-sectional image of the adductor canal corresponding to the insertion point at the midthigh level. A fish-oil pill (FOP) was used to mark the insertion point. Spread of local anaesthetic can be seen as a triangular shape in the adductor canal (arrow). ALM, adductor longus muscle; SM, sartorius muscle; VMM, vastus medialis muscle. (b) Coronary image of the thigh showing longitudinal spread of local anaesthetic in the adductor canal. The yellow line marks the level of the corresponding cross-sectional image in a. British Journal of Anaesthesia 2015 115, 920-926DOI: (10.1093/bja/aev362) Copyright © 2015 The Author(s) Terms and Conditions