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High- Versus Low-Stimulation Current Threshold for Axillary Plexus Blocks: A Prospective Randomized Triple-Blinded Noninferiority Trial in 205 Patients.
MedLine Citation:
PMID:  23223121     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
BACKGROUND:For nerve stimulator-guided regional anesthesia, one has to compromise between a presumed low success rate (using a high-current threshold) and a presumed increased risk of nerve damage (using a low-current threshold). We hypothesized that high-current thresholds in the range of 0.9 to 1.1 mA are not inferior with respect to the procedural and latency times compared with low threshold currents in the range of 0.3 to 0.5 mA for nerve stimulation in brachial plexus blocks.METHODS:Two hundred five patients scheduled for elective surgery were randomized to a low (0.3-0.5 mA, n = 103) or a high (0.9-1.1 mA, n = 102) stimulation current threshold for the axillary plexus block with 40 mL local anesthetic mixture (20 mL, each of prilocaine 1% and ropivacaine 0.75%). The primary end point was the time to complete sensory block. The secondary outcome measures were the time to readiness for surgery (defined as the time from the start of block procedure to complete sensory block) and the block performance time. The noninferiority margin was set at 5 minutes and was evaluated using the two-sided 95% bootstrap-confidence intervals ([CIs] 100,000 replications) for differences in means.RESULTS:The mean times to complete sensory block revealed a significant decrease with the low-current group (17.9 ± 12.1 (mean ± SD) versus 22.8 ± 12.4 minutes; 95% CI, 1.1 to 8.6; p = 0.012). The time to readiness for surgery was 30.3 ± 13.8 minutes in the low-current group and 31.7 ± 12.9 minutes in the high-current group (95% CI, -2.7 to 5.5; p = 0.49). The performance time was significantly shorter in the high-current threshold group (9.5 ± 4.7 versus 11.9 ± 5.7 minutes; 95% CI, -4 to 1.1; p = 0.001).CONCLUSION:Noninferiority for the high-current threshold technique could neither be confirmed for the primary end point nor for secondary end points. However, we consider a difference in mean times of approximately 8.5 minutes to achieve readiness for surgery acceptable for clinical practice.
Authors:
Timon Vassiliou; Hans-Helge Müller; Angela Ellert; Pascal Wallot; Kuo-Min Kwee; Michaela Beyerle; Leopold Eberhart; Hinnerk Wulf; Thorsten Steinfeldt
Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-12-7
Journal Detail:
Title:  Anesthesia and analgesia     Volume:  -     ISSN:  1526-7598     ISO Abbreviation:  Anesth. Analg.     Publication Date:  2012 Dec 
Date Detail:
Created Date:  2012-12-10     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  1310650     Medline TA:  Anesth Analg     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Affiliation:
From the *Department of Anesthesiology and Critical Care, University Hospital Giessen-Marburg, Philipps University Marburg, Marburg, Germany; †Institute for Medical Informatics, Biometry and Epidemiology, Ludwig-Maximilians-University, Munich, Germany; ‡Department of Anesthesiology and Intensive Care, Hospital Reinbek St. Adolf-Stift, Reinbek, Germany; and §Department of Anesthesiology and Intensive Care Medicine, Asklepios-Klinik Harburg, Hamburg, Germany.
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