Comparison of Relaxometry Between Ulnar Nerve and Posterior Tibial Nerve After Cisatracurium Administration Using Electromyography

Abstract

Background: Electromyography can be used for quantitative neuromuscular monitoring during general anesthesia, mostly using the stimulation train-of-four (TOF) pattern. Relaxometry measures the muscular response of the adductor pollicis muscle to electrical stimulation of the ulnar nerve, which is routinely used in clinical practices for monitoring the neuromuscular block. However, when it is not always possible to be used for all patients, the posterior tibial nerve is a suitable alternative. Objectives: Using electromyography, we compared the neuromuscular block between the ulnar and the posterior tibial nerves. Methods: In this study, the participants were 110 patients who met inclusion criteria and submitted their written consent. Following the administration of cisatracurium intravenously, the patients had relaxometry performed simultaneously on the ulnar and the posterior tibial nerves using electromyography. Results: Eighty-seven patients were included in the final analysis. The onset time was 296 ± 99 s at the ulnar nerve and 346 ± 146 s at the tibial nerve, with a mean difference of -50 s and a standard deviation of 164 s. The 95% limits of agreement ranged from -372 s to 272 s. The relaxation time was 105 ± 26 min at the ulnar nerve and 87 ± 25 min at the tibial nerve, with a mean difference of 18 min and a standard deviation of 20 min. Conclusions: Using electromyography, no statistically significant difference was noticed between the ulnar and the posterior tibial nerve during the neuromuscular block. The onset time and the relaxation time assessed with an electromyogram to compare the stimulation of the ulnar and posterior tibial nerves showed large limits of agreement.

Methods for Clinical Monitoring of Neuromuscular Transmission in Anesthesiology – A Review

“…44 A different study suggests that there is no statistically significant difference between the onset and recovery of neuromuscular block using electromyography for the ulnar and posterior tibial nerves. 45 The order of the electrodes marked with a color code from the distal to the proximal area of the body is important, according to the manufacturer’s recommendations. 46 When measuring the diaphragm action potential, recording electrodes are placed on the right side of the spine (Th12 / L1 or L1 / L2) and the right phrenic nerve is stimulated transcutaneously in the cervical segment.…”