A comparison of motor stimulation threshold in ultrasound-guided interscalene brachial plexus block for arthroscopic shoulder surgery: a randomized trial

Jeong, Ji Seon; Shim, Jae Chol; Shim, Jae Hang; Han, Kyoung Hee

doi:10.1007/s12630-015-0553-2

Cited by 6 publications

(5 citation statements)

References 17 publications

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“…Moreover, our data show that performing three different methods of nerve localisation does not require a significant additional time and, definitely, it does not delay surgery. Not by chance, the block execution time was similar to the one showed by other studies without the use of triple monitoring [13,20], while the block onset time was consistent with the one found in other experiences using similar dosage of local anaesthetic [21,22].…”

Section: Discussionsupporting

confidence: 89%

“…In this way, it was possible to control in real time the needle tip which was placed between C5 and C6 brachial plexus roots (Figure 3). With the needle tip in place, the second control was performed through NS, verifying the absence of a motor response at a stimulation intensity ≤ 0.5 mA; in case of a motor response, the needle tip was repositioned under ultrasound guidance [13,14].…”

Section: Methodsmentioning

confidence: 99%

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Triple Monitoring May Avoid Intraneural Injection during Interscalene Brachial Plexus Block for Arthroscopic Shoulder Surgery: A Prospective Preliminary Study

Porcellini

Strumia

Costa

et al. 2021

JCM

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Nerve injury is a feared complication of peripheral nerve blockade. The aim of this study was to test the effectiveness of a triple monitoring (TM), i.e., a combination of ultrasound (US), nerve stimulation (NS) and opening injection pressure (OIP) during interscalene brachial plexus block (IBPB) for surgery of the shoulder. Sixty patients undergoing IBPB for shoulder arthroscopy received TM. BSmart®, an inline injection device connected to a 10 mL syringe, was used to detect OIP during IBPB. Nerve stimulation was set to 0.5 mA to rule out any motor response, and if OIP was below 15 PSI, 10 mL of local anaesthetic was injected under US guidance between the C5 and C6 roots. The main outcome was the ability of TM to detect a needle–nerve contact. Other outcomes including the duration of IBPB; pain during injection; postoperative neurologic dysfunction. Triple monitoring revealed needle–nerve contact in 33 patients (55%). In 18 patients, NS evoked motor responses despite first control with US; in a further 15 patients, BSmart® detected an OIP higher than 15 PSI, despite the absence of motor response to NS. Mean duration of IBPB was 67.2 ± 5.3 seconds; neither pain during injection nor postoperative neurologic dysfunctions were detected. Clinical follow up excluded the presence of postoperative neuropathies. Triple monitoring showed to be a useful and feasible tool while performing IBPB for arthroscopic shoulder surgery. Future studies will be needed to confirm our findings.

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Section: Discussionsupporting

confidence: 89%

Section: Methodsmentioning

confidence: 99%

Triple Monitoring May Avoid Intraneural Injection during Interscalene Brachial Plexus Block for Arthroscopic Shoulder Surgery: A Prospective Preliminary Study

Porcellini

Strumia

Costa

et al. 2021

JCM

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“…After confirming that the aspiration test was negative, 10 mg of the study drug were injected. Then the needle was repositioned in the neural cluster; once a threshold current less than 0.5 mA 14 was confirmed, the remaining 15.1 ml of the study drug were injected.…”

Section: Methodsmentioning

confidence: 99%

The effect of epinephrine on the perfusion index during ultrasound-guided supraclavicular brachial plexus block: a randomized controlled trial

Kim

Jeong

Park

et al. 2020

Sci Rep

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The perfusion index (PI) is an objective tool used to assess a successful nerve block. Epinephrine is a widely used adjuvant to local anesthetics, and it may affect PI values because of the vasoconstrictive property. The aim of this study was to investigate the influence of epinephrine on PI as an indicator of a successful block in ultrasound-guided supraclavicular brachial plexus block (SCBPB). In this randomized controlled trial, 82 adult patients underwent upper limb surgery under SCBPB were recruited between July 2018 and March 2019 in a single tertiary care center. Participants were randomly assigned to one of two groups: non-epinephrine group (n = 41) or epinephrine group (5 mcg ml −1 , n = 41). The primary outcome was the comparison of the "PI ratio 10," which was defined as the ratio of the PI 10 to the baseline. Receiver operating characteristic (ROC) curves were constructed to determine the accuracy of the PI in predicting the block success at each time interval. The PI ratio 10 was 2.7 (1.9-4.0) in non-epinephrine group and 3.3 (2.2-4.4) in epinephrine group (median difference: 0.4; 95% confidence interval [CI] − 1.1 to 0.2; P = 0.207). The ROC curves compared without group identification were not significantly different over time. The cutoff value for the PI and PI ratio at 5 min (PI ratio 5) were 7.7 (area under the ROC [AUROC]: 0.89, 95% CI 0.83-0.94) and 1.6 (AUROC: 0.94, 95% CI 0.90-0.98), respectively. The perineural epinephrine did not affect the PI following a SCBPB. The PI ratio 5 > 1.6 might be considered as a relatively accurate predictor of a successful SCBPB. Trial registration: This study was registered at the Clinical Trial Registry of Korea (https ://cris.nih.go.kr. CriS No. KCT0003006).

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“…After sterile skin preparation with a solution of chlorhexidine 2% in isopropyl alcohol 70% and skin infiltration with 1 mL of 1% lidocaine, a sterile 50-mm, 22-gauge insulated nerve-stimulating needle (PAJUNK, Geisingen, Germany) was inserted in-plane technique until the needle tip was adjacent to the C5 and C6 roots under ultrasound guidance (Export; SonoSite, Bothell, Washington), and appropriate needle position was confirmed at a threshold current less than 0.5 mA. 15 After negative aspiration test for blood, 15 mL of 0.5% ropivacaine (epinephrine 1:200,000) was injected. After ISBPB, sensory block was assessed every 5 minutes for 30 minutes by pinprick test in the corresponding C5 and C6 sensory dermatome distribution.…”

Section: Isbpb Techniquementioning

confidence: 99%

Effective Dose of Intravenous Dexmedetomidine to Prolong the Analgesic Duration of Interscalene Brachial Plexus Block

Kang

Jeong

Yoo

et al. 2018

Regional Anesthesia and Pain Medicine

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A comparison of motor stimulation threshold in ultrasound-guided interscalene brachial plexus block for arthroscopic shoulder surgery: a randomized trial

Cited by 6 publications

References 17 publications

Triple Monitoring May Avoid Intraneural Injection during Interscalene Brachial Plexus Block for Arthroscopic Shoulder Surgery: A Prospective Preliminary Study

Triple Monitoring May Avoid Intraneural Injection during Interscalene Brachial Plexus Block for Arthroscopic Shoulder Surgery: A Prospective Preliminary Study

The effect of epinephrine on the perfusion index during ultrasound-guided supraclavicular brachial plexus block: a randomized controlled trial

Effective Dose of Intravenous Dexmedetomidine to Prolong the Analgesic Duration of Interscalene Brachial Plexus Block

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