Predicting caudal epidural analgesia using nerve stimulation

Tsui, Ban C. H.

doi:10.1046/j.1365-2044.2001.02181-28.x

Cited by 7 publications

(2 citation statements)

References 7 publications

(8 reference statements)

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“…These findings are in agreement with other studies in the literature that tested the efficacy of the EEST for thoracic, lumbar, and caudal epidural catheter placement in non-obstetric subjects. [7][8][9] On the other hand, our results also suggest that the EEST cannot be used to predict the spread or consumption of local anesthetic solutions, in contrast to our hypothesis. We found no difference in the EEST current requirements or in the bupivacaine consumption in the first two hours of analgesia when comparing women with adequate or inadequate blocks and those with symmetric or asymmetric blocks.…”

Section: Discussioncontrasting

confidence: 87%

The epidural electric stimulation test does not predict local anesthetic spread or consumption in labour epidural analgesia

Margarido

Dlacic

Balki

et al. 2013

Can J Anesth/J Can Anesth

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Purpose The epidural electrical stimulation test (EEST) is a highly specific and sensitive test for confirming placement of the epidural catheter in the epidural space. The purpose of this study was to investigate if the EEST could predict the spread and consumption of local anesthetic solutions during labour epidural analgesia. Methods This observational study was conducted in labouring parturients requesting epidural analgesia. The EEST was performed after the epidural catheter placement (T0) and repeated five minutes after a test dose with 2% lidocaine 3 mL (T1). The minimum current required to elicit the motor response at each time point was recorded.A loading dose of 0.125% bupivacaine 10 mL and fentanyl 50 lg was administered and followed by patient-controlled epidural analgesia with 0.0625% bupivacaine and fentanyl 2 lgÁmL -1 (baseline infusion 10 mLÁhr -1 , bolus dose 5 mL, lockout interval ten minutes, maximum dose 20 mLÁhr -1 ). The primary outcome was the correlation between the current required to elicit motor responses at T0 and T1 and the consumption of bupivacaine in the first two hours of epidural administration. The secondary outcomes included the muscle contraction patterns determined by the EEST and the incidence of failed, inadequate, or asymmetric blocks. Results The study was conducted in 102 parturients. The mean electric current required to elicit muscle response was 4.43 mA (range 1-10 mA) at T0, 5.97 mA (range 1-14 mA) at T1, and the mean D (T1-T0) current was 1.54 mA (range 0-8 mA). There was no correlation between either the mean baseline current required or the D (T1-T0) current and the total bupivacaine consumption at two hours. The incidence of inadequate blocks at two hours was 18%; however, none of the catheters required replacement. Unilateral left (34%) or right (31%) leg contraction was the most frequent pattern elicited by the EEST. Conclusions The EEST shows a wide range of electrical current requirements and elicits a variety of muscle twitch patterns on the lower limbs. Although it confirms the epidural placement of the catheter, the EEST cannot be used to predict the spread or consumption of the local anesthetic solution during labour epidural analgesia. RésuméObjectif Le test de stimulation e´lectrique pe´ridurale (TSEP) est un test extreˆmement spe´cifique et sensible qui

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Section: Discussioncontrasting

confidence: 87%

The epidural electric stimulation test does not predict local anesthetic spread or consumption in labour epidural analgesia

Margarido

Dlacic

Balki

et al. 2013

Can J Anesth/J Can Anesth

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“…The epidural stimulation test was performed as described by Tsui et al 17 The anode lead of the nerve stimulator was connected to an electrode on the patient's upper extremity. The nerve stimulator was set at a frequency of 1 Hz and a pulse width of 0.2 msec.…”

Section: Methodsmentioning

confidence: 99%

Electrophysiological stimulation (Tsui test) is feasible for epidural catheter positioning in adults with chronic back pain: a cohort study

McAuliffe

Pickworth

DiRenna

et al. 2013

Can J Anesth/J Can Anesth

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Purpose Determining epidural catheter placement and accurately depositing corticosteroids at the site of the pathology in adults with chronic back pain can be challenging. Fluoroscopy is considered the standard of care for guiding epidural catheter positioning and subsequent injection in patients receiving epidural corticosteroids, but the technique has some limitations. We hypothesized that electrophysiological stimulation using the Tsui test is feasible for determining the appropriate epidural catheter position in adults with chronic back pain receiving epidural corticosteroids. Methods We conducted a prospective cohort study of 12 patients receiving epidural corticosteroid injections for chronic back pain. Anatomical landmarks and epidural needle positions were initially confirmed by fluoroscopy. Epidural catheter position was assessed according to sensory and motor responses, as described by Tsui et al. (Can J Anaesth 45: 640-644, 1998). The current was increased slowly from zero until muscle activity was visible or the current reached 10 mA. The catheter was then advanced until muscle responses occurred in the desired myotome. The test was deemed positive or negative according to the Tsui criteria. The anatomical level was confirmed by fluoroscopy prior to injection. Results Electrophysiological stimulation effectively established the appropriate epidural catheter position in 11 patients (92%). Epidural stimulation occurred at a mean (SD) threshold of 3.95 (3.35) mA. The kappa statistic between interventions was 0.65, indicating a substantial level of agreement. Conclusion This study demonstrated that electrophysiological stimulation using the Tsui technique is feasible for epidural catheter positioning in adults with chronic back pain. It may optimize epidural steroid injection in this population. RésuméObjectif Il peut être difficile de déterminer le positionnement du cathéter péridural et de placer de façon précise les corticostéroïdes au site de la lésion chez les adultes souffrant de maux de dos chroniques. La fluoroscopie est considérée comme la norme de soins pour guider le positionnement du cathéter péridural et l'injection subséquente chez les patients recevant des corticostéroïdes par voie péridurale, mais la technique comporte certaines limites. Nous avons émis l'hypothèse que la stimulation électrophysiologique réalisée à l'aide du test de Tsui était faisable pour déterminer le positionnement adéquat du cathéter péridural chez les adultes souffrant de maux de dos Author contributions Niamh McAuliffe made substantial contributions to conception and design, acquisition of data, analysis and interpretation of data; drafted the article and revised the manuscript; and approved the final version to be published. Sharon Pickworth made substantial contributions to conception and design, acquisition of data; revised the manuscript; and approved the final version to be published. Tania DiRenna made substantial contributions to conception and design, acquisition of data; and revised the manuscript;...

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Monitoring intraoperative effectiveness of caudal analgesia through skin temperature variation

Ehrlich

Vedulla

Cottrell

et al. 2003

Journal of Pediatric Surgery

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Predicting caudal epidural analgesia using nerve stimulation

Cited by 7 publications

References 7 publications

The epidural electric stimulation test does not predict local anesthetic spread or consumption in labour epidural analgesia

The epidural electric stimulation test does not predict local anesthetic spread or consumption in labour epidural analgesia

Electrophysiological stimulation (Tsui test) is feasible for epidural catheter positioning in adults with chronic back pain: a cohort study

Monitoring intraoperative effectiveness of caudal analgesia through skin temperature variation

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