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Painful paresthesiae are infrequent during brachial plexus localization using low-current peripheral nerve
Pelin Karaca1, Admir Hadzic, Marina Yufa
1College of Physicians and Surgeons of Columbia University, New York, NY, USA.
Regional Anesthesia and Pain Medicine
|October 14, 2003
Summary
Low-intensity electrical nerve stimulation for brachial plexus blocks can cause paresthesia (tingling) in over half of patients when specifically asked. This sensation is generally mild and does not indicate a failed block, ensuring patient comfort.
Area of Science:
- Anesthesiology
- Neuroscience
- Pain Management
Background:
- Controversy exists regarding the link between paresthesia and nerve stimulation during procedures.
- Understanding paresthesia frequency is crucial for patient comfort during nerve blocks.
Purpose of the Study:
- To determine the incidence of paresthesia during low-intensity electrical stimulation for brachial plexus identification.
- To assess patient-reported sensations during interscalene block procedures.
Main Methods:
- Low-intensity current nerve stimulation (0.6 mA, 200 µs, 2 Hz) was used in 64 patients undergoing shoulder/arm surgery.
- Patients were queried about paresthesia during nerve localization while maintaining a motor response.
- Block adequacy was assessed via sensory distribution, motor strength, and anesthesia effectiveness.
Main Results:
- While 95% achieved satisfactory anesthesia, 55% reported paresthesia (dull tingling) only upon specific questioning.
- No patients spontaneously reported paresthesia during stimulation.
- Most patients (71%) reported mild, radiating paresthesia upon initial local anesthetic injection.
Conclusions:
- Low-current nerve stimulation for brachial plexus blocks can be performed with minimal patient discomfort.
- Slow needle advancement and low-current intensity minimize the occurrence of painful paresthesiae.
- Electrical paresthesia, when elicited, is a common finding and does not preclude successful block.