Intensity of the Stimulating Current May Not Be a Reliable Indicator of Intraneural Needle Placement

Tsai, Tony P.; Vučković, Ilvana; Dilberović, Faruk; Obhodzas, Muamer; Kapur, Eldan; Divanović, Kučuk-Alija; Hadžić, Admir

doi:10.1097/00115550-200805000-00003

Cited by 103 publications

(34 citation statements)

References 10 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…92 Several studies using in vivo models have shown that the minimum stimulating current may not reliably reflect the distance of the needle tip from the nerve. [93][94][95][96] Furthermore, the nerve stimulation technique cannot reliably differentiate whether the needle tip is within the muscle or lying in a plane between muscles (an important consideration when botulinum toxin is being injected). Both electrophysiological approaches neither allow direct visualization of the muscle nor ensure accurate positioning of the needle within the PM.…”

Section: Limitation Of the Current Techniquesmentioning

confidence: 99%

Brief review: Piriformis syndrome: etiology, diagnosis, and management

Jankovic¹,

Peng

Zundert

2013

Can J Anesth/J Can Anesth

130

View full text Add to dashboard Cite

In this narrative review, we aim to provide the pathophysiology and diagnostic criteria of the piriformis syndrome (PS), an underdiagnosed cause of buttock and leg pain that can be difficult to treat. Based on existing evidence, frequencies of clinical features are estimated in patients reported to have PS. In view of the increasing popularity of ultrasound for intervention, the ultrasound-guided technique in the treatment of PS is described in detail. A literature search of the MEDLINEA (R) database was performed from January 1980 to December 2012 using the search terms e.g., " piriformis injection", " ultrasound guided piriformis injection", " botulinum toxin", "pain management", and different structures relevant in this review. There was no restriction on language. A review of the medical literature pertaining to PS revealed that the existence of this entity remains controversial. There is no definitive proof of its existence despite reported series with large numbers of patients. Piriformis syndrome continues to be a controversial diagnosis for sciatic pain. Electrophysiological testing and nerve blocks play important roles when the diagnosis is uncertain. Injection of local anesthetics, steroids, and botulinum toxin into the piriformis muscle can serve both diagnostic and therapeutic purposes. An ultrasound-guided injection technique offers improved accuracy in locating the piriformis muscle. Optimizing the therapeutic approach requires an interdisciplinary evaluation of treatment

show abstract

Section: Limitation Of the Current Techniquesmentioning

confidence: 99%

Brief review: Piriformis syndrome: etiology, diagnosis, and management

Jankovic¹,

Peng

Zundert

2013

Can J Anesth/J Can Anesth

130

View full text Add to dashboard Cite

show abstract

“…Periferik sinir stimülasyonu ''kör'' teknik olarak adlandırılır, çünkü iğnenin ve hedef dokuların görülmesi mümkün değildir, sinirin inerve ettiği kas kontraksiyonlarına göre sinire olan mesafe tahmin edilebilir. [1][2][3] Tekrarlayan girişimler komplikasyonlara neden olabilir, bu durum özellikle pnömo-toraks riskinin fazla olduğu supraklaviküler bölgede önemlidir. [4,5] Blok esnasında USG kullanılması eş zamanlı olarak iğneyi, sinirleri, plevra ve damarlar gibi korunması gereken yapıları ve enjeksiyon esnasında lokal anesteziğin dağılımının görülmesini de sağlar.…”

Section: Introductionunclassified

Comparison of Ultrasound guided supraclavicular and infraclavicular approaches for brachial plexus blockade.

Gürkan¹,

Hoşten²,

Tekïn³

et al. 2012

Agri

View full text Add to dashboard Cite

SummaryObjectives: Ultrasound-guided supraclavicular and infraclavicular blocks are commonly used for upper extremity surgery. The primary aims of our study were to compare block success, block onset times and performance times; secondary aims were to compare the number of needle advancements, and incidence of adverse events of ultrasound-guided supraclavicular or infraclavicular blocks. Methods: 110 patients were randomized into two groups: supraclavicular (Group S) and infraclavicular (Group I). All the patients were given a mixture of 20 ml 0.5% levobupivacaine and 10 ml 2% lidocaine as local anesthetics. The sensory score of the seven terminal nerves was assessed every 10 min for 30 min. Results: Block success (Group I: 92.7%; Gorup S: 83.6%) and block onset time (Group I: 12.5±4.8; Group S: 11.6±3.9 min) were similar between the groups. Block performance time was shorter in Group I, than Group S (194.4±65; 226.3±59 sec, P<0.05 ÖzetAmaç: Ultrason rehberliğinde yapılan supraklaviküler ve infraklaviküler bloklar üst ekstremite cerrahisinde sıklıkla uygulanmaktadır. Bu çalışmanın birinci amacı ultrason rehberliğinde yapılan supraklaviküler ve infraklaviküler blokların, blok başarısı, blok başlama zamanı ve blok uygulama zamanının, ikinci amacı ise iğne yönlendirme sayısının ve istenmeyen yan etkilerin görülme sıklığının karşılaştırılmasıydı.Gereç ve Yöntem: Hastalar (n=110) supraklaviküler (Grup S) ve infraklaviküler (Grup İ) olmak üzere iki gruba ayrıldı. Lokal anestezik olarak tüm hastalara 20 ml %5'lik levobupivakain ve 10 ml %2'lik lidokain karışımı uygulandı. Duyu skoru yedi terminal sinirde 30 dk boyunca her 10 dk da bir olarak değerlendirildi. Bulgular: Gruplar arasında blok oluşma süresi (Grup İ: 12.5±5; Grup S: 11.6±4 dk) ve blok başarısı (Grup İ: %92.7; Grup S: %83.6) benzerdi. Blok uygulama süresi Grup İ' de Grup S' den anlamlı derecede kısaydı (194.4±65; 226.3±59 sn) (p<0.05) İğne yönlendirme sayısı Grup İ' de Grup S' den anlamlı derecede azdı (p<0.05). Grup İ' deki hastalarda ulnar ve median sinirlerin blokajı Grup S' deki hastalardan, Grup S' deki hastalarda ise medial kutanöz sinirin blokajı Grup İ' dekilerden anlamlı derecede başarılı idi (p<0.05). Grup S' de 9 hastada (%16.3) Horner sendromu, bir hastada (%1.8) parestezi görüldü. Sonuç:İnfraklaviküler ve supraklaviküler yaklaşımla blok özellikleri benzer bulunmuştur ancak infraklaviküler yaklaşım geçici yan etkilerinin daha az olması nedeniyle supraklaviküler bloğa tercih edilebilir.Anahtar sözcükler: Horner sendromu; infraklaviküler brakiyal pleksus bloğu; pnömotoraks; supraklaviküler brakiyal pleksus bloğu.

show abstract

“…The use of nerve stimulation is not universally accepted as a reliable method of preventing intraneural injection [15,16]. The resolution provided by currently available real-time ultrasound imaging may show an expansion of a nerve with injection, but does not prevent intraneural injection and, as yet, is unable to differentiate intrafascicular from epineural injection [17].…”

Section: Discussionmentioning

confidence: 99%

The effect of needle dimensions and infusion rates on injection pressures in regional anaesthesia needles: a bench-top study

et al. 2014

View full text Add to dashboard Cite

SummaryAnimal studies have shown that injection pressures > 75 kPa indicate probable intrafascicular needle tip position. This study describes the flow/pressure characteristics of seven common needle systems. A syringe pump delivered flow rates of 5, 6.67, 10, 13.3, 15 and 20 ml.min À1 through these needle systems, while keeping the needle tips open to atmosphere. A pressure transducer connected between the syringe and needle provided a real-time graphical display for analysis. Mean plateau pressures increased linearly with flow and with decreasing needle diameter (2.7-92 kPa). Flow rates > 17 ml.min À1 and needle sizes 22 G and smaller produced mean plateau pressures > 75 kPa.Pressure monitors upstream from the needle may produce false-positive alarms at high flow rates due to needle resistance, and unreliable readings due to non-laminar flow. We recommend injection rates ≤ 15 ml.min À1 (0.25 ml.s À1 )to reduce the effect of factors upstream from the needle tip as a cause of high pressure readings.

show abstract

Intensity of the Stimulating Current May Not Be a Reliable Indicator of Intraneural Needle Placement

Cited by 103 publications

References 10 publications

Brief review: Piriformis syndrome: etiology, diagnosis, and management

Brief review: Piriformis syndrome: etiology, diagnosis, and management

Comparison of Ultrasound guided supraclavicular and infraclavicular approaches for brachial plexus blockade.

The effect of needle dimensions and infusion rates on injection pressures in regional anaesthesia needles: a bench-top study

Contact Info

Product

Resources

About