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The supraclavicular block with a nerve stimulator: to decrease or not to decrease, that is the question.

Carlo D Franco1, Vitaliy Domashevich, Gennadiy Voronov

  • 1Department of Anesthesiology and Pain Management, John H. Stroger Jr. Hospital of Cook County, Chicago, Illinois.

Anesthesia and Analgesia
|March 26, 2004
PubMed
Summary
This summary is machine-generated.

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For supraclavicular nerve blocks, eliciting a motor twitch at 0.9 mA is sufficient for immediate local anesthetic injection. Reducing current to 0.5 mA does not improve block quality or patient satisfaction.

Area of Science:

  • Anesthesiology
  • Regional Anesthesia
  • Nerve Blockade

Background:

  • Portable nerve stimulators are standard for nerve blocks, with motor response at low currents generally improving success rates.
  • Current practice involves decreasing stimulator output before anesthetic injection, but optimal current levels remain undetermined.
  • The type of motor response, not just the current, may be crucial for successful nerve blocks.

Purpose of the Study:

  • To test if a motor twitch elicited at 0.9 mA in the fingers during supraclavicular block allows immediate local anesthetic injection.
  • To evaluate if reducing current to 0.5 mA offers benefits over 0.9 mA for supraclavicular block quality.

Main Methods:

  • Sixty patients were randomized into two groups for supraclavicular block.

Related Experiment Videos

  • Group 1 received injection after a motor twitch at 0.5 mA; Group 2 received injection after a similar twitch at 0.9 mA.
  • Block success was defined by complete sensory blockade in the hand within 30 minutes.

    • Main Results:

    • All 59 evaluable patients (100%) achieved successful blockades.
    • Onset of anesthesia (10.9 min vs. 11.4 min) and duration were similar between groups.
    • Patient satisfaction and absence of complications were comparable in both the 0.5 mA and 0.9 mA groups.

    Conclusions:

    • A visible motor twitch in the fingers at 0.9 mA is adequate for immediate local anesthetic injection during supraclavicular block.
    • Decreasing the nerve stimulator output to 0.5 mA is not necessary and does not enhance block quality or patient experience.
    • This finding simplifies the procedure by eliminating the need for current reduction before injection.