The threshold current in the intrathecal space to elicit motor response is lower and does not overlap that in the epidural space: a porcine model

Tsui, Ban C. H.; Wagner, Alese; Finucane, Brendan T.

doi:10.1007/bf03018427

Cited by 24 publications

(20 citation statements)

References 21 publications

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“…13,15 In those studies, 3.6 ± 0.6 mA (mean ± SD) was required to cause muscle twitching in response to electric stimulation applied in the epidural space at several levels of the spinal cord (C7, T14-15, L6-7, and S4). In the present study, the MET was 0.3 ± 0.07 (mean ± SEM), one-tenth that found in pigs.…”

Section: Discussionmentioning

confidence: 99%

“…Then a stimulus with a frequency of 1 Hz, pulse width of 0.1 milliseconds, and current of 5 mA was applied to the needle as described. 13,15 Then nerve stimulation was started, and when hind limb muscle twitching was present, electric current was decreased by 0.3 mA until no muscle twitching could be seen. Then the current was increased by 0.3 mA to reestablish muscle response; this value was recorded as the MET.…”

Section: Methodsmentioning

confidence: 99%

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Evaluation of electric neurostimulation to confirm correct placement of lumbosacral epidural injections in dogs

Garcia‐Pereira

Hauptman²,

Shih

et al. 2010

ajvr

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Evaluation of electric neurostimulation to confirm correct placement of lumbosacral epidural injections in dogs

Garcia‐Pereira

Hauptman²,

Shih

et al. 2010

ajvr

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“…However, the inability to aspirate blood or cerebrospinal fluid is not an absolute indication that an epidural needle or catheter is not in the intrathecal or intravascular space. The use of electrical stimulation for epidural anesthesia may not only be useful to confirm epidural catheter placement, but the threshold current for motor response may also predict intrathecal placement (33,38,50,51). When a catheter is situated properly within the epidural space, a current much greater than 1 mA should be required to elicit muscle twitches (30,31,52).…”

Section: Clinical Applications Detecting Intrathecal and Intravasculamentioning

confidence: 99%

“…As previously mentioned, inadvertent intrathecal or intraneural needle placement may possibly be identified by patient reports of paresthesia or pain upon injection. Because pediatric patients are deeply sedated or under general anesthesia during placement of the neuraxial block, the electrical stimulation test may be an additional safety measure to alert the clinician of needle proximity to the intrathecal space, spinal cord or nerve root (50,61). Thus, while it may not be advantageous for catheter placement verification with these blocks, electrical stimulation may still be useful.…”

Section: Clinical Applications Detecting Intrathecal and Intravasculamentioning

confidence: 99%

Innovative Approaches to Neuraxial Blockade in Children: The Introduction of Epidural Nerve Root Stimulation and Ultrasound Guidance for Epidural Catheter Placement

Tsui

2006

Pain Research and Management

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Continuous epidural blockade remains the cornerstone of pediatric regional anesthesia. However, the risk of catastrophic trauma to the spinal cord when inserting direct thoracic and high lumbar epidural needles in anesthetized or heavily sedated pediatric patients is a concern. To reduce this risk, research has focused on low lumbar or caudal blocks (ie, avoiding the spinal cord) and threading catheters from distal puncture sites in a cephalad direction. However, with conventional epidural techniques, including loss-of-resistance for localization of the needle, optimal catheter tip placement is difficult to assess because considerable distances are required during threading. Novel approaches include electrical epidural stimulation for physiological confirmation and segmental localization of epidural catheters, and ultrasound guidance for assessing related neuroanatomy and real-time observation of the needle puncture and, potentially, catheter advancement. The present article provides a brief and focused review of these two advances, and outlines recent clinical experiences relevant to pediatric epidural anesthesia.

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“…20 Alternatively, a modification of the Tsui test may be used to facilitate correct spinal needle placement by providing objective information, in addition to the return of CSF via the needle. 21 In previous studies, a different dose-response relationship has been shown in electrical stimulation for the epidural and the intrathecal space. [22][23][24] When it is not clear that returning fluid is CSF, confirmation of placement may be obtained by passing an electrical current through an insulated spinal needle.…”

mentioning

confidence: 95%

L’échec de la rachianesthésie après le bloc de la loge du psoas

Lang

Prusinkiewicz

Tsui

2005

Can J Anesth/J Can Anesth

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P Pu ur rp po os se e: : To report the case of a patient who experienced failed spinal anesthesia following a psoas compartment block (PCB) and discuss its implications.C Cl li in ni ic ca al l f fe ea at tu ur re es s: : A 70-yr-old male was scheduled for a right total hip arthroplasty. He agreed to a PCB for postoperative analgesia and a spinal anesthetic. The spinal anesthetic was performed after completion of the PCB. Free flow of clear fluid was demonstrated at the beginning and at the end of the presumed intrathecal injection. General anesthesia had to be induced because of failure of the spinal anesthetic. The patient awoke from his general anesthetic with a functional PCB and no evidence of residual neuraxial anesthesia. The possibility of epidural spread of local anesthetic from the PCB impairing the ability to perform spinal anesthesia is discussed and reviewed. We hypothesize that local anesthetic in the epidural space may have falsely reassured the anesthesiologist that the needle was properly placed.C Co on nc cl lu us si io on n: : We describe a case of failed spinal anesthesia following a PCB and discuss its implications. Objectif : Présenter le cas d'un patient chez qui la rachianesthésie a échoué à la suite d'un bloc de la loge du psoas (BLP) et discuter des implications. Conclusion : Nous décrivons un cas d'échec de la rachianesthésie à la suite d'un BLP et discutons de ses implications.HE primary causes of failed spinal anesthesia remain elusive. 1-3 Factors suggested to favour failure of spinal anesthesia include failure to demonstrate free flow of cerebrospinal fluid (CSF), the choice of local anesthetic and adjuvant, technical factors related to a patient's body morphology (e.g., kyphoscoliosis), the judgement and experience of the anesthesiologist and variable CSF volume. 1 Reported failure rates are definition-dependent and vary from 0.8% to 17%. 2,4 The traditional end-point for confirmation of proper placement of a needle during the performance of a spinal anesthetic is free flow of clear fluid from the needle hub. In normal circumstances, when this endpoint is obtained it is unusual for spinal anesthesia to fail. 2 However, assuming that the clear fluid that flows from a needle tip is CSF may lead to failure of spinal anesthesia. 5 We report a case of failed spinal anesthesia following a psoas compartment block (PCB) and hypothesize that local anesthetic in the epidural space may have falsely reassured the anesthesiologist that the needle was properly placed.

show abstract

The threshold current in the intrathecal space to elicit motor response is lower and does not overlap that in the epidural space: a porcine model

Cited by 24 publications

References 21 publications

Evaluation of electric neurostimulation to confirm correct placement of lumbosacral epidural injections in dogs

Evaluation of electric neurostimulation to confirm correct placement of lumbosacral epidural injections in dogs

Innovative Approaches to Neuraxial Blockade in Children: The Introduction of Epidural Nerve Root Stimulation and Ultrasound Guidance for Epidural Catheter Placement

L’échec de la rachianesthésie après le bloc de la loge du psoas

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