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Zhang GY, Chen YF, Dai WX, Zhang D, Huang Y, He WZ, Lin CX. Diabetic Peripheral Neuropathy Increases Electrical Stimulation Threshold of Sciatic Nerve: A Prospective Parallel Cohort Study. Diabetes Metab Syndr Obes 2020; 13:4447-4455. [PMID: 33239897 PMCID: PMC7680690 DOI: 10.2147/dmso.s277473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Accepted: 11/03/2020] [Indexed: 11/23/2022] Open
Abstract
PURPOSE To investigate the impact of diabetic peripheral neuropathy and its severity on the threshold of sciatic nerve electrical stimulation in diabetic patients. PATIENTS AND METHODS The case-control study included 60 patients that were divided into non-diabetic patients (control group, n = 26) and diabetic patients (diabetes group, n = 34). All the patients who were scheduled for lower leg, foot, and ankle surgery received a popliteal sciatic nerve block. We recorded the minimum current required to produce motor activity of the sciatic nerve during ultrasound-guided popliteal sciatic nerve block. RESULTS Among the 60 patients, the sciatic nerve innervated muscle contractile response was successfully elicited in 57 patients (dorsiflexion of foot, plantar flexion, foot valgus or adduction, toe flexion, etc.) under electric stimulation. We failed to elicit the motor response in three patients with diabetic peripheral neuropathy, even when the stimulation current was 3 mA. The average electrical stimulation threshold (1.0 ± 0.7 mA) in the diabetes group was significantly higher than that of the control group (0.4 ± 0.1 mA). Diabetic patients with peripheral neuropathy had a higher electrical stimulation threshold (1.2 ± 0.7 mA) than patients without peripheral neuropathy (0.4 ± 0.1 mA). Furthermore, the electrical stimulation threshold of the sciatic nerve in diabetic patients had a linear dependence on the Toronto Clinical Scoring System (TCSS) peripheral neuropathy score (electrical stimulation threshold [in mA] = 0.125 TCSS score) (P < 0.001). CONCLUSION The threshold of electrical stimulation to elicit a motor response of the sciatic nerve was increased in diabetic patients, and the threshold of electrical stimulation of the sciatic nerve increased with the severity of diabetic nerve dysfunction.
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Affiliation(s)
- Guang Ying Zhang
- Department of Anesthesiology, The First Affiliated Hospital of Guangxi Medical University, Nanning, People’s Republic of China
| | - Yi Feng Chen
- Department of Anesthesiology, The First Affiliated Hospital of Guangxi Medical University, Nanning, People’s Republic of China
| | - Wei Xin Dai
- Department of Anesthesiology, The First Affiliated Hospital of Guangxi Medical University, Nanning, People’s Republic of China
| | - Dan Zhang
- Department of Anesthesiology, The First Affiliated Hospital of Guangxi Medical University, Nanning, People’s Republic of China
| | - Yi Huang
- Department of Anesthesiology, The First Affiliated Hospital of Guangxi Medical University, Nanning, People’s Republic of China
| | - Wen Zheng He
- Department of Anesthesiology, The First Affiliated Hospital of Guangxi Medical University, Nanning, People’s Republic of China
| | - Cheng Xin Lin
- Department of Anesthesiology, The First Affiliated Hospital of Guangxi Medical University, Nanning, People’s Republic of China
- Correspondence: Cheng Xin Lin; Wen Zheng He Department of Anesthesiology, The First Affiliated Hospital of Guangxi Medical University, No. 6 Shuangyong Road, Qingxiuqu, Nanning530022, People’s Republic of China Email ;
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Salviz EA, Onbasi S, Ozonur A, Orhan-Sungur M, Berkoz O, Tugrul KM. Comparison of Ultrasound-Guided Axillary Brachial Plexus Block Properties in Diabetic and Nondiabetic Patients: A Prospective Observational Study. J Hand Surg Am 2017; 42:190-197. [PMID: 28259276 DOI: 10.1016/j.jhsa.2017.01.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Revised: 12/31/2016] [Accepted: 01/11/2017] [Indexed: 02/02/2023]
Abstract
PURPOSE Patients with diabetes mellitus (DM) type 2 may have subclinical peripheral nerve neuropathy. We performed this study to compare the differences in duration of axillary brachial plexus blocks in patients with type 2 DM and without DM (NODM). Our hypothesis was that the sensory block duration would be prolonged in patients with DM. METHODS A total of 71 patients who were scheduled for elective forearm and/or hand surgery were enrolled in this study. Before surgery, they received ultrasound-guided axillary brachial plexus blocks with a mixture of 10 mL lidocaine 2% and 20 mL bupivacaine 0.5%. After surgery, all patients received 1 g paracetamol every 6 hours as needed. The primary end point was sensory block duration. Secondary end points were motor block duration, time until first pain (numeric rating scale [NRS] 4 or greater), highest NRS pain scores, and rescue analgesic consumption (NRS 4 or greater) through the first 2 postoperative days. RESULTS In all, 67 patients completed the study: 22 in the DM group and 45 in the NODM group. Sensory and motor block durations were longer in the DM group than in the NODM group (mean [range], 773.5 [479-1155] vs 375 [113-900] minutes, and 523 [205-955] vs 300 [110-680] minutes). Time until first pain was 855 (590-1,285) minutes in the DM group and 500 (200-990) minutes in the NODM group. The highest NRS scores were also significantly lower in the DM group at 6 and 12 hours. Paracetamol consumption was lower in the DM group through the first 2 postoperative days. CONCLUSIONS The presence of DM was associated with longer duration of the sensory block after axillary brachial plexus block. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic II.
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Affiliation(s)
- Emine Aysu Salviz
- Department of Anesthesiology, Division of Hand, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey.
| | - Sukru Onbasi
- Department of Anesthesiology, Division of Hand, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Anil Ozonur
- Department of Anesthesiology, Division of Hand, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Mukadder Orhan-Sungur
- Department of Anesthesiology, Division of Hand, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Omer Berkoz
- Department of Plastic and Reconstructive Surgery, Division of Hand, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Kamil Mehmet Tugrul
- Department of Anesthesiology, Division of Hand, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
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Neuburger M, Schwemmer U, Volk T, Gogarten W, Kessler P, Steinfeldt T. [Localization of peripheral nerves. Success and safety with electrical nerve stimulation]. Anaesthesist 2014; 63:422-8. [PMID: 24715260 DOI: 10.1007/s00101-014-2312-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Peripheral electrical nerve stimulation is one of the standard applications in peripheral regional anesthesia in addition to the ultrasound technique. Among other findings, the visualization of needle and nerve during ultrasound-guided blockade caused a change in clinical practice of peripheral nerve stimulation in the last decade. In the present article old and new aspects of principles and clinical practice of the nerve stimulation technique are presented and summarized in a total clinical concept in order to achieve safe and successful peripheral regional anesthesia using electrical peripheral nerve stimulation.
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Affiliation(s)
- M Neuburger
- Abteilung für Anästhesie und Intensivmedizin, Ortenau Klinikum Achern, Josef-Wurzler-Str. 7, 77855, Achern, Deutschland,
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Tsui BC. The effects of general anaesthesia on nerve-motor response characteristics (rheobase and chronaxie) to peripheral nerve stimulation. Anaesthesia 2014; 69:374-9. [DOI: 10.1111/anae.12540] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/08/2013] [Indexed: 11/30/2022]
Affiliation(s)
- B. C. Tsui
- Department of Anesthesia and Pain Medicine; University of Alberta; Edmonton Alberta Canada
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Increased electrical nerve stimulation threshold of the sciatic nerve in patients with diabetic foot gangrene. Eur J Anaesthesiol 2013; 30:435-40. [DOI: 10.1097/eja.0b013e328360bd85] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Abstract
Peripheral nerve stimulation has a long history in regional anesthesia. Despite the advent of ultrasound-guided peripheral nerve blockade, nerve stimulation remains a popular technique used alone or, now, in combination with ultrasound-guided techniques. In light of this evolving utility of nerve stimulation, this is an appropriate time to review the basic concepts and knowledge base of this historically important tool. Electrical nerve stimulation facilitates nerve localization, using threshold current as a surrogate for needle-to-nerve distance. Preferential activation of motor nerves is possible because motor nerve fibers are more readily activated with a shorter duration of current compared with sensory nerves. The association between current and needle-to-nerve distance predicts that less current is needed to evoke a motor response as the needle moves closer to the nerve. Thus, an elicited motor response at or below 0.5 mA is considered a common end point for successful neural blockade. However, current magnitude is neither 100% sensitive nor specific. Independent of technical ability, both the biological environment and the equipment used impact the current-distance relationship. Thus, successful electrical nerve stimulation is dependent on an anesthesiologist with a solid foundation in anatomy and a thorough understanding of electrophysiology.
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Abstract
Modern anesthesia is handling an increasing number of patients with neurological diseases who require narcosis. Regional anesthesia techniques offer qualities which might be advantageous for this group particularly for childbirth. The number of pregnant women with neurological diseases has increased significantly in the recent years due to improved diagnostics and therapy. A more careful approach to regional anesthesia in patients with neurological diseases is necessary as the drugs themselves possess neurotoxic effects and the procedure might worsen the underlying neurological diseases. Additionally, performing regional anesthesia might be more complicated and the resulting blockade might be different from the expected neuronal block. Published data concerning regional anesthesia in this patient group are limited and mainly restricted to case reports. In this review general considerations regarding regional anesthesia, techniques, drugs and methods in these patient groups will be discussed. In the second part the practical approach to regional anesthesia for some of the most important neurological diseases is highlighted.
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Affiliation(s)
- B Sinner
- Klinik für Anästhesiologie, Universität Regensburg, Franz-Josef-Strauss Allee 11, 93053 Regensburg.
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Villegas Duque A, Ortiz de la Tabla González R, Martínez Navas A, Echevarría Moreno M. [Continuous femoral block for postoperative analgesia in a patient with poliomyelitis]. REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2010; 57:123-124. [PMID: 20337008 DOI: 10.1016/s0034-9356(10)70179-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
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Ribeiro L, Lobo C, Magalhães J, Correia C. 878 THE EFFICACY OF A COMBINED APPROACH TO GUIDE PERIPHERAL CATHETER PLACEMENT TO CONTROL ISCHEMIC LIMB PAIN. Eur J Pain 2009. [DOI: 10.1016/s1090-3801(09)60881-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- L. Ribeiro
- Centro Hospitalar Alto Ave, Guimarães, Portugal
| | - C. Lobo
- Centro Hospitalar Alto Ave, Guimarães, Portugal
| | | | - C. Correia
- Centro Hospitalar Alto Ave, Guimarães, Portugal
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Guidance of block needle insertion by electrical nerve stimulation: a pilot study of the resulting distribution of injected solution in dogs. Anesthesiology 2008; 109:473-8. [PMID: 18719445 DOI: 10.1097/aln.0b013e318182af0b] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Little is known regarding the final needle tip location when various intensities of nerve stimulation are used to guide block needle insertion. Therefore, in control and hyperglycemic dogs, the authors examined whether lower-intensity stimulation results in injection closer to the sciatic nerve than higher-threshold stimulation. METHODS During anesthesia, the sciatic nerve was approached with an insulated nerve block needle emitting either 1 mA (high-current group, n = 9) or 0.5 mA (low-current group, n = 9 in control dogs and n = 6 in hyperglycemic dogs). After positioning to obtain a distal motor response, the lowest current producing a response was identified, and ink (0.5 ml) was injected. Frozen sections of the tissue revealed whether the ink was in contact with the epineurium of the nerve, distant to it, or within it. RESULTS In control dogs, the patterns of distribution using high-threshold (final current 0.99 +/- 0.03 mA, mean +/- SD) and low-threshold (final current 0.33 +/- 0.08 mA) stimulation equally showed ink that was in contact with the epineurium or distant to it. One needle placement in the high-threshold group resulted in intraneural injection. In hyperglycemic dogs, all needle insertions used a low-threshold technique (n = 6, final threshold 0.35 +/- 0.08 mA), and all resulted in intraneural injections. CONCLUSIONS In normal dogs, current stimulation levels in the range of 0.33-1.0 mA result in needle placement comparably close to the sciatic nerve but do not correlate with distance from the target nerve. In this experimental design, low-threshold electrical stimulation does not offer satisfactory protection against intraneural injection in the presence of hyperglycemia.
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Ultrasound-guided peripheral regional blockade in patients with Charcot-Marie-Tooth disease: a review of three cases. Can J Anaesth 2008; 55:515-20. [DOI: 10.1007/bf03016671] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
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van Geffen GJ, McCartney CJL, Gielen M, Chan VWS. Ultrasound as the only nerve localization technique for peripheral nerve block. J Clin Anesth 2007; 19:381-5. [PMID: 17869993 DOI: 10.1016/j.jclinane.2006.10.015] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2006] [Revised: 10/01/2006] [Accepted: 10/08/2006] [Indexed: 11/26/2022]
Abstract
Ultrasound facilitates the performance of peripheral nerve blocks and may increase block quality parameters. In this report, we show that ultrasonographic guidance makes peripheral nerve blocks possible in patients in whom the traditional methods of nerve localization are limited. Four cases are described in which conventional end points for successful blocks would have been impossible to use, whereas ultrasound guidance was successful and safe. The latter method increases applicability in a larger group of patients.
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Affiliation(s)
- Geert J van Geffen
- Radboud University Medical Centre, Institute for Anesthesiology, P.O. Box 9101, Nijmegen 6500 HB, The Netherlands.
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Use of Radiographic Contrast to Confirm the Placement of a Sciatic Catheter in a Patient Presenting an Atypical Response to Neurostimulation. Reg Anesth Pain Med 2006. [DOI: 10.1097/00115550-200609000-00021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Laser literature watch. Photomed Laser Surg 2006; 24:537-71. [PMID: 16942439 DOI: 10.1089/pho.2006.24.537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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