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Electric Nerve Stimulation Does Not Correctly Predict Needle-Nerve Distance and Potential Local Anesthetic Spread for
Stefan Fielmuth1, Marek Szalata, Heidi Sievert
1From the *Klinik für Anästhesiologie und Intensivmedizin; †Klinik für Orthopädie, Dietrich Bonhoeffer Klinikum Neubrandenburg, Neubrandenburg, Germany; and ‡Klinik für Anästhesiologie, Universitätsmedizin Greifswald, Greifswald, Germany.
Anesthesia and Analgesia
|April 4, 2017
Summary
Electric nerve stimulation for locating nerves during shoulder surgery showed limited success. The technique accurately identified needle-nerve distance in less than half of patients, with fluid spread also being insufficient in many cases.
Area of Science:
- Anesthesiology
- Neurosurgery
- Medical Imaging
Background:
- Accurate nerve localization is crucial for regional anesthesia and surgical procedures.
- Electric nerve stimulation is a common tool for guiding needle placement near nerves.
- Ultrasound imaging enhances visualization of needle-nerve proximity and fluid spread.
Purpose of the Study:
- To evaluate the efficacy of electric nerve stimulation in achieving correct needle-nerve distance.
- To assess the spread of saline injected via electric nerve stimulation during shoulder surgery.
- To determine the success rate of electric nerve stimulation as a nerve localization tool.
Main Methods:
- Ultrasound imaging was used to assess needle tip position relative to the nerve.
- Motor responses were elicited in 43 patients undergoing shoulder surgery.
- The distance between the needle tip and the closest nerve was measured.
- Saline spread was evaluated using ultrasound after injection.
Main Results:
- The needle tip was within 4 mm of the nerve in 21 patients (48.8%).
- The needle tip was in direct contact with the nerve in 7 patients.
- The needle tip was 6-18 mm away from the nerve in 15 patients.
- Saline did not reach the brachial plexus in 21 patients (48.8%).
- Successful identification of correct needle-nerve distance was achieved in 48.8% of cases.
- Successful fluid spread to the target area was achieved in 51.2% of cases.
Conclusions:
- Electric nerve stimulation demonstrated suboptimal accuracy for precise needle-nerve distance identification in shoulder surgery.
- The ability of injected saline to reach the target nerve plexus was also limited.
- Further refinement of electric nerve stimulation techniques or alternative methods may be necessary for improved nerve localization and regional anesthesia efficacy.