| Extraneural versus intraneural stimulation thresholds during ultrasound-guided supraclavicular block. | |
| | |
MedLine Citation:
|
PMID: 19417603 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
|
BACKGROUND: A stimulation current of no more than 0.5 mA is regarded as safe in avoiding nerve injury and delivering adequate stimulus to provoke a motor response. However, there is no consistent level of stimulating threshold that reliably indicates intraneural placement of the needle. The authors determined the minimally required stimulation threshold to elicit a motor response outside and inside the most superficial part of the brachial plexus during high-resolution, ultrasound-guided, supraclavicular block. METHODS: After institutional review board approval, ultrasound-guided, supraclavicular block was performed on 55 patients. Patients with neurologic dysfunction were excluded. Criteria for extraneural and intraneural stimulation were defined and assessed by independent experts. To determine success rate and any residual neurologic deficit, qualitative sensory and motor examinations were performed before and after block placement. At 6 month follow-up, the patients were examined for any neurologic deficit. RESULTS: Thirty-nine patients met all set stimulation criteria. Median +/- SD (interquartile range) minimum stimulation threshold outside was 0.60 +/- 0.37 mA (0.40, 1.0) and inside 0.30 +/- 0.19 mA (0.20, 0.40). The difference of 0.30 mA was statistically significant (P < 0.0001). Stimulation currents of 0.2 mA or less were not observed outside the trunk in any patient. Significantly higher thresholds were observed in diabetic patients. Success rate was 100% after 20 min. Thirty-four patients had normal sensory and motor examination at 6 months. Five patients were lost to follow-up. CONCLUSION: Within the limitations of this study and the use of ultrasound, a stimulation current of 0.2 mA or less is reliable to detect intraneural placement of the needle. Furthermore, stimulation currents of more than 0.2 and no more than 0.5 mA could not rule out intraneural position. |
| | |
Authors:
|
Paul E Bigeleisen; Nizar Moayeri; Gerbrand J Groen |
Related Documents
:
|
7516653 - Histological comparison of the third interdigital nerve in patients with morton's metat... 6716113 - The guillain-barré syndrome: clinical and electroneuromyographic studies. 12440663 - Aortic complications after bicuspid aortic valve replacement: long-term results. |
Publication Detail:
|
Type: Journal Article; Research Support, Non-U.S. Gov't |
Journal Detail:
|
Title: Anesthesiology Volume: 110 ISSN: 1528-1175 ISO Abbreviation: Anesthesiology Publication Date: 2009 Jun |
Date Detail:
|
Created Date: 2009-05-26 Completed Date: 2009-06-16 Revised Date: 2009-12-29 |
Medline Journal Info:
|
Nlm Unique ID: 1300217 Medline TA: Anesthesiology Country: United States |
Other Details:
|
Languages: eng Pagination: 1235-43 Citation Subset: AIM; IM |
Affiliation:
|
Department of Anesthesiology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA. Paul_Bigeleisen@urmc.rochester.edu |
Export Citation:
|
APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
|
Adolescent Adult Aged Aged, 80 and over Brachial Plexus / anatomy & histology, ultrasonography* Diabetes Mellitus / physiopathology Electric Stimulation* Female Follow-Up Studies Hand / surgery Humans Image Processing, Computer-Assisted Male Middle Aged Motor Neurons / physiology Muscle Contraction / physiology Muscle, Skeletal / innervation, physiology Needles Nerve Block / instrumentation, methods* Pain Threshold Sensory Receptor Cells / physiology Wrist / surgery Young Adult |
| Comments/Corrections | |
Comment In:
|
Anesthesiology. 2010 Jan;112(1):250-1; author reply 251-2
[PMID:
20032713
]
|
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
Previous Document: Is the performance of acceleromyography improved with preload and normalization?: a comparison with ...
Next Document: Feasibility of tobacco interventions in anesthesiology practices: a pilot study.