Intensity of the Stimulating Current May Not Be a Reliable Indicator of Intraneural Needle Placement
The current intensity at which a motor response is elicited with an intraneural needle placement has been inadequately studied. We hypothesized that electrical current delivered through an intraneurally placed needle does not always result in an evoked motor response. Our secondary objective was to...
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| Veröffentlicht in: | Regional anesthesia and pain medicine 2008-05, Vol.33 (3), p.207-210 |
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| creator | Tsai, Tony P. Vuckovic, Ilvana Dilberovic, Faruk Obhodzas, Muamer Kapur, Eldan Divanovic, Kucuk-Alija Hadzic, Admir |
| description | The current intensity at which a motor response is elicited with an intraneural needle placement has been inadequately studied. We hypothesized that electrical current delivered through an intraneurally placed needle does not always result in an evoked motor response. Our secondary objective was to determine the relationship between electrical current intensity and needle-to-nerve distance.
Twenty pigs were given general anesthesia and the sciatic nerves (SN) were exposed bilaterally. Electrical nerve stimulation was applied 2
cm, 1
cm, 0.5
cm, 0.2
cm, and 0.1
cm away from the SN, transepineurally, and intraneurally (in the subepineurium). Stimulation was started at 2.0 mA and decreased to the minimal current at which visible motor response was obtained. Two blinded observers agreed on the intensity and type of motor response. Specific response of SN was defined as a distal motor response (hoof twitch); nonspecific response was defined as a local muscle twitch (no hoof response).
At a distance of 0.5 cm to 2 cm away from the SN, only nonspecific muscle responses were observed. Specific SN responses were obtained starting at 0.1 cm away from the nerve and transepineurally with currents of 0.92 ± 0.33 mA (median 1.00 mA; range 0.24-1.48 mA) and 0.39 ± 0.33 mA (median 0.3 mA; range 0.15-1.4 mA), respectively. With the needle tip positioned intraneurally, specific motor response could be obtained at 0.56 ± 0.54 mA (median 0.3 mA; range 0.08-1.80 mA). Five (12.5%) intraneurally positioned needles only elicited a specific motor response at 0.8-1.8 mA.
Specific response to nerve stimulation with currents |
| doi_str_mv | 10.1016/j.rapm.2007.12.010 |
| format | Article |
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Twenty pigs were given general anesthesia and the sciatic nerves (SN) were exposed bilaterally. Electrical nerve stimulation was applied 2
cm, 1
cm, 0.5
cm, 0.2
cm, and 0.1
cm away from the SN, transepineurally, and intraneurally (in the subepineurium). Stimulation was started at 2.0 mA and decreased to the minimal current at which visible motor response was obtained. Two blinded observers agreed on the intensity and type of motor response. Specific response of SN was defined as a distal motor response (hoof twitch); nonspecific response was defined as a local muscle twitch (no hoof response).
At a distance of 0.5 cm to 2 cm away from the SN, only nonspecific muscle responses were observed. Specific SN responses were obtained starting at 0.1 cm away from the nerve and transepineurally with currents of 0.92 ± 0.33 mA (median 1.00 mA; range 0.24-1.48 mA) and 0.39 ± 0.33 mA (median 0.3 mA; range 0.15-1.4 mA), respectively. With the needle tip positioned intraneurally, specific motor response could be obtained at 0.56 ± 0.54 mA (median 0.3 mA; range 0.08-1.80 mA). Five (12.5%) intraneurally positioned needles only elicited a specific motor response at 0.8-1.8 mA.
Specific response to nerve stimulation with currents <0.2 mA occurred only when the needle tip was positioned intraneurally. However, motor response could be absent with intraneural needle placement at a current intensity of up to 1.7 mA.</description><identifier>ISSN: 1098-7339</identifier><identifier>EISSN: 1532-8651</identifier><identifier>DOI: 10.1016/j.rapm.2007.12.010</identifier><identifier>PMID: 18433670</identifier><language>eng</language><publisher>England: Elsevier Inc</publisher><subject>Anesthesia, General ; Animals ; Electric Conductivity ; Evoked Potentials, Motor - physiology ; Female ; Male ; Needles ; Nerve localization ; Nerve stimulation ; Regional anesthesia ; Sciatic Nerve ; Single-Blind Method ; Stimulating current ; Swine ; Transcutaneous Electric Nerve Stimulation - instrumentation</subject><ispartof>Regional anesthesia and pain medicine, 2008-05, Vol.33 (3), p.207-210</ispartof><rights>2008 American Society of Regional Anesthesia and Pain Medicine</rights><rights>Copyright Churchill Livingstone Inc., Medical Publishers May/Jun 2008</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c381t-5f49bf32e130f3b6bca921615b04e4c0222d0f8e58f4ec4de212bca34ce7f1c73</citedby></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,27903,27904</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/18433670$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Tsai, Tony P.</creatorcontrib><creatorcontrib>Vuckovic, Ilvana</creatorcontrib><creatorcontrib>Dilberovic, Faruk</creatorcontrib><creatorcontrib>Obhodzas, Muamer</creatorcontrib><creatorcontrib>Kapur, Eldan</creatorcontrib><creatorcontrib>Divanovic, Kucuk-Alija</creatorcontrib><creatorcontrib>Hadzic, Admir</creatorcontrib><title>Intensity of the Stimulating Current May Not Be a Reliable Indicator of Intraneural Needle Placement</title><title>Regional anesthesia and pain medicine</title><addtitle>Reg Anesth Pain Med</addtitle><description>The current intensity at which a motor response is elicited with an intraneural needle placement has been inadequately studied. We hypothesized that electrical current delivered through an intraneurally placed needle does not always result in an evoked motor response. Our secondary objective was to determine the relationship between electrical current intensity and needle-to-nerve distance.
Twenty pigs were given general anesthesia and the sciatic nerves (SN) were exposed bilaterally. Electrical nerve stimulation was applied 2
cm, 1
cm, 0.5
cm, 0.2
cm, and 0.1
cm away from the SN, transepineurally, and intraneurally (in the subepineurium). Stimulation was started at 2.0 mA and decreased to the minimal current at which visible motor response was obtained. Two blinded observers agreed on the intensity and type of motor response. Specific response of SN was defined as a distal motor response (hoof twitch); nonspecific response was defined as a local muscle twitch (no hoof response).
At a distance of 0.5 cm to 2 cm away from the SN, only nonspecific muscle responses were observed. Specific SN responses were obtained starting at 0.1 cm away from the nerve and transepineurally with currents of 0.92 ± 0.33 mA (median 1.00 mA; range 0.24-1.48 mA) and 0.39 ± 0.33 mA (median 0.3 mA; range 0.15-1.4 mA), respectively. With the needle tip positioned intraneurally, specific motor response could be obtained at 0.56 ± 0.54 mA (median 0.3 mA; range 0.08-1.80 mA). Five (12.5%) intraneurally positioned needles only elicited a specific motor response at 0.8-1.8 mA.
Specific response to nerve stimulation with currents <0.2 mA occurred only when the needle tip was positioned intraneurally. However, motor response could be absent with intraneural needle placement at a current intensity of up to 1.7 mA.</description><subject>Anesthesia, General</subject><subject>Animals</subject><subject>Electric Conductivity</subject><subject>Evoked Potentials, Motor - physiology</subject><subject>Female</subject><subject>Male</subject><subject>Needles</subject><subject>Nerve localization</subject><subject>Nerve stimulation</subject><subject>Regional anesthesia</subject><subject>Sciatic Nerve</subject><subject>Single-Blind Method</subject><subject>Stimulating current</subject><subject>Swine</subject><subject>Transcutaneous Electric Nerve Stimulation - instrumentation</subject><issn>1098-7339</issn><issn>1532-8651</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2008</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><sourceid>GNUQQ</sourceid><recordid>eNp9kVuLFDEQhYMo7rr6B3yQ4INv3VuV9CUNvujgZWDdFS_PIZ2uaIa-jEl6Yf69GWZA8GGfqqC-cyjOYewlQomAzfWuDGY_lQKgLVGUgPCIXWItRaGaGh_nHTpVtFJ2F-xZjDsAUG3VPGUXqCopmxYu2bCdE83RpwNfHE-_iX9PflpHk_z8i2_WEGhO_Is58Nsl8ffEDf9Gozf9SHw7D96atISjNPsEM9MazMhviYZ8_zoaS1PWP2dPnBkjvTjPK_bz44cfm8_Fzd2n7ebdTWGlwlTUrup6JwWhBCf7premE9hg3UNFlQUhxABOUa1cRbYaSKDIjKwstQ5tK6_Ym5PvPix_VopJTz5aGsf82LJG3XQoVU4rg6__A3fLGub8mxZQY1e3qsuQOEE2LDEGcnof_GTCQSPoYwF6p48F6GMBGoXOBWTRq7Pz2k80_JOcE8_A2xNAOYh7T0FH62m2NPhANulh8Q_5_wUiaZbN</recordid><startdate>20080501</startdate><enddate>20080501</enddate><creator>Tsai, Tony P.</creator><creator>Vuckovic, Ilvana</creator><creator>Dilberovic, Faruk</creator><creator>Obhodzas, Muamer</creator><creator>Kapur, Eldan</creator><creator>Divanovic, Kucuk-Alija</creator><creator>Hadzic, Admir</creator><general>Elsevier Inc</general><general>BMJ Publishing Group LTD</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>88I</scope><scope>8AF</scope><scope>8AO</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>HCIFZ</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M1P</scope><scope>M2P</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>Q9U</scope><scope>S0X</scope><scope>7X8</scope></search><sort><creationdate>20080501</creationdate><title>Intensity of the Stimulating Current May Not Be a Reliable Indicator of Intraneural Needle Placement</title><author>Tsai, Tony P. ; Vuckovic, Ilvana ; Dilberovic, Faruk ; Obhodzas, Muamer ; Kapur, Eldan ; Divanovic, Kucuk-Alija ; Hadzic, Admir</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c381t-5f49bf32e130f3b6bca921615b04e4c0222d0f8e58f4ec4de212bca34ce7f1c73</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2008</creationdate><topic>Anesthesia, General</topic><topic>Animals</topic><topic>Electric Conductivity</topic><topic>Evoked Potentials, Motor - physiology</topic><topic>Female</topic><topic>Male</topic><topic>Needles</topic><topic>Nerve localization</topic><topic>Nerve stimulation</topic><topic>Regional anesthesia</topic><topic>Sciatic Nerve</topic><topic>Single-Blind Method</topic><topic>Stimulating current</topic><topic>Swine</topic><topic>Transcutaneous Electric Nerve Stimulation - instrumentation</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Tsai, Tony P.</creatorcontrib><creatorcontrib>Vuckovic, Ilvana</creatorcontrib><creatorcontrib>Dilberovic, Faruk</creatorcontrib><creatorcontrib>Obhodzas, Muamer</creatorcontrib><creatorcontrib>Kapur, Eldan</creatorcontrib><creatorcontrib>Divanovic, Kucuk-Alija</creatorcontrib><creatorcontrib>Hadzic, Admir</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Nursing & Allied Health Database</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Science Database (Alumni Edition)</collection><collection>STEM Database</collection><collection>ProQuest Pharma Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>SciTech Premium Collection</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Science Database</collection><collection>Nursing & Allied Health Premium</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>ProQuest Central Basic</collection><collection>SIRS Editorial</collection><collection>MEDLINE - Academic</collection><jtitle>Regional anesthesia and pain medicine</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Tsai, Tony P.</au><au>Vuckovic, Ilvana</au><au>Dilberovic, Faruk</au><au>Obhodzas, Muamer</au><au>Kapur, Eldan</au><au>Divanovic, Kucuk-Alija</au><au>Hadzic, Admir</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Intensity of the Stimulating Current May Not Be a Reliable Indicator of Intraneural Needle Placement</atitle><jtitle>Regional anesthesia and pain medicine</jtitle><addtitle>Reg Anesth Pain Med</addtitle><date>2008-05-01</date><risdate>2008</risdate><volume>33</volume><issue>3</issue><spage>207</spage><epage>210</epage><pages>207-210</pages><issn>1098-7339</issn><eissn>1532-8651</eissn><abstract>The current intensity at which a motor response is elicited with an intraneural needle placement has been inadequately studied. We hypothesized that electrical current delivered through an intraneurally placed needle does not always result in an evoked motor response. Our secondary objective was to determine the relationship between electrical current intensity and needle-to-nerve distance.
Twenty pigs were given general anesthesia and the sciatic nerves (SN) were exposed bilaterally. Electrical nerve stimulation was applied 2
cm, 1
cm, 0.5
cm, 0.2
cm, and 0.1
cm away from the SN, transepineurally, and intraneurally (in the subepineurium). Stimulation was started at 2.0 mA and decreased to the minimal current at which visible motor response was obtained. Two blinded observers agreed on the intensity and type of motor response. Specific response of SN was defined as a distal motor response (hoof twitch); nonspecific response was defined as a local muscle twitch (no hoof response).
At a distance of 0.5 cm to 2 cm away from the SN, only nonspecific muscle responses were observed. Specific SN responses were obtained starting at 0.1 cm away from the nerve and transepineurally with currents of 0.92 ± 0.33 mA (median 1.00 mA; range 0.24-1.48 mA) and 0.39 ± 0.33 mA (median 0.3 mA; range 0.15-1.4 mA), respectively. With the needle tip positioned intraneurally, specific motor response could be obtained at 0.56 ± 0.54 mA (median 0.3 mA; range 0.08-1.80 mA). Five (12.5%) intraneurally positioned needles only elicited a specific motor response at 0.8-1.8 mA.
Specific response to nerve stimulation with currents <0.2 mA occurred only when the needle tip was positioned intraneurally. However, motor response could be absent with intraneural needle placement at a current intensity of up to 1.7 mA.</abstract><cop>England</cop><pub>Elsevier Inc</pub><pmid>18433670</pmid><doi>10.1016/j.rapm.2007.12.010</doi><tpages>4</tpages></addata></record> |
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| ispartof | Regional anesthesia and pain medicine, 2008-05, Vol.33 (3), p.207-210 |
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| subjects | Anesthesia, General Animals Electric Conductivity Evoked Potentials, Motor - physiology Female Male Needles Nerve localization Nerve stimulation Regional anesthesia Sciatic Nerve Single-Blind Method Stimulating current Swine Transcutaneous Electric Nerve Stimulation - instrumentation |
| title | Intensity of the Stimulating Current May Not Be a Reliable Indicator of Intraneural Needle Placement |
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