Electrical Stimulation of the Epidural Space Using a Catheter With a Removable Stylet

Charghi, Roshanak; Chan, Sher Yi; Kardash, Kenneth J.; Finlayson, Roderick J.; Tran, De Q.H.

doi:10.1097/00115550-200703000-00010

Cited by 14 publications

(5 citation statements)

References 13 publications

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“…The advantage of NS is that it does not expose patients to contrast or radiation and it can be conducted using equipment that is typically already available to anesthesiologists. Despite being described over 20 years ago [9,[11][12][13][14], its use has not been widely adopted. This may be due to the perceived complexity of setting up a circuit with conventional catheters and a saline bridge [14].…”

Section: Discussionmentioning

confidence: 99%

A Randomized Comparison of Loss of Resistance Versus Loss of Resistance Plus Electrical Stimulation: Effect On Success of Thoracic Epidural Placement

Dobson

Weller

Edwards

et al. 2021

Preprint

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Background: Loss of resistance (LOR) for epidural catheter placement has been utilized for almost a century. LOR is a subjective endpoint associated with a high failure rate. Nerve stimulation (NS) has been described as an objective method for confirming placement of an epidural catheter. We hypothesized that the addition of NS to LOR would improve the success of epidural catheter placement.Methods: One-hundred patients were randomized to thoracic epidural analgesia (TEA) utilizing LOR-alone or loss of resistance plus nerve stimulation (LOR+NS). The primary endpoint was rate of success, defined as loss of sensation following test dose. Secondary endpoints included performance time. An intention-to-treat analysis was planned, but a per-protocol analysis was performed to investigate the success rate when stimulation was achieved.Results: In the intention-to-treat analysis there was no difference in success rates (90% vs 82% [LOR+NS vs LOR-alone]; P = 0.39). The procedural time increased in the LOR+NS group (33.9 ± 12.8 vs 24.0 ± 8.0 min; P < 0.001). The per-protocol analysis found a statistically higher success rate for the LOR+NS group compared to the LOR-alone group (98% vs. 82%; P = 0.017) when only patients in whom stimulation was achieved were included.Conclusions: Addition of NS technique did not statistically improve the success rate for epidural placement when analyzed in an intention-to-treat format and was associated with a longer procedural time. In a per-protocol analysis a statistically higher success rate for patients in whom stimulation was obtained highlights the potential benefit of adding NS to LOR.Trial registration: ClinicalTrials.gov identifier NCT03087604 on 3/22/2017; Institutional Review Board Wake Forest School of Medicine IRB00039522, Food and Drug Administration Investigational Device Exemption: G160273.

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Section: Discussionmentioning

confidence: 99%

A Randomized Comparison of Loss of Resistance Versus Loss of Resistance Plus Electrical Stimulation: Effect On Success of Thoracic Epidural Placement

Dobson

Weller

Edwards

et al. 2021

Preprint

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“…They observed no differences, with sensitivities and specificities of 80% and 100%, respectively, when compared with the clinical response as per the acute pain team's postoperative assessment. Charghi et al 17 evaluated the reliability of the EEST for thoracic epidural placement of a single-port, metal coil-reinforced epidural catheter (Teracath) containing a removable stylet, and found the sensitivity and specificity to be 92% and 83%, respectively, following a LA loading dose. Although these findings are close to what we report, the EEST device differed from the ones we used, and the EEST was not compared with a LA test dose.…”

Section: Discussionmentioning

confidence: 99%

“…With the EEST, low-amplitude electrical current is applied to the epidural catheter following its insertion and evoked muscle contraction is sought. While this technique has been studied in various patient populations with excellent results, [13][14][15][16][17] it remains relatively unfamiliar to most anesthesia health care providers. Moreover, none of the previous studies compared EEST with the LA test dose to assess the correct thoracic epidural catheter position.…”

Section: Résumémentioning

confidence: 99%

Epidural electrical stimulation test versus local anesthetic test dose for thoracic epidural catheter placement: a prospective observational study

Balki

Malavade

et al. 2019

Can J Anesth/J Can Anesth

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Purpose This study examined the concordance between epidural electrical stimulation test (EEST) and local anesthetic (LA) test dose to indicate correct thoracic epidural catheter position. The relationship between the test results and epidural postoperative analgesia was also assessed. Methods This prospective observational cohort study was done in patients receiving thoracic epidural analgesia for abdominal surgery. After insertion, the epidural catheter was tested using a nerve stimulator to elicit a motor response. The LA test dose was then administered, and sensory block to ice and pinprick was assessed. The primary outcome was the presence/absence of motor response to EEST and sensory block to test dose. Concordance of responses was assessed using kappa statistics, and their predictive power of postoperative epidural analgesia was evaluated.

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“…A 19G catheter (Arrow Flex Tip Plus: Arrow International, Reading, PA, USA) was connected to a nerve stimulator via an adaptor (Johans ECG Adaptor; Arrow International). 15,16 The catheter was filled with normal saline and advanced into the epidural space.…”

Section: Methodsmentioning

confidence: 99%

Electrophysiological stimulation (Tsui test) is feasible for epidural catheter positioning in adults with chronic back pain: a cohort study

McAuliffe

Pickworth

DiRenna

et al. 2013

Can J Anesth/J Can Anesth

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Purpose Determining epidural catheter placement and accurately depositing corticosteroids at the site of the pathology in adults with chronic back pain can be challenging. Fluoroscopy is considered the standard of care for guiding epidural catheter positioning and subsequent injection in patients receiving epidural corticosteroids, but the technique has some limitations. We hypothesized that electrophysiological stimulation using the Tsui test is feasible for determining the appropriate epidural catheter position in adults with chronic back pain receiving epidural corticosteroids. Methods We conducted a prospective cohort study of 12 patients receiving epidural corticosteroid injections for chronic back pain. Anatomical landmarks and epidural needle positions were initially confirmed by fluoroscopy. Epidural catheter position was assessed according to sensory and motor responses, as described by Tsui et al. (Can J Anaesth 45: 640-644, 1998). The current was increased slowly from zero until muscle activity was visible or the current reached 10 mA. The catheter was then advanced until muscle responses occurred in the desired myotome. The test was deemed positive or negative according to the Tsui criteria. The anatomical level was confirmed by fluoroscopy prior to injection. Results Electrophysiological stimulation effectively established the appropriate epidural catheter position in 11 patients (92%). Epidural stimulation occurred at a mean (SD) threshold of 3.95 (3.35) mA. The kappa statistic between interventions was 0.65, indicating a substantial level of agreement. Conclusion This study demonstrated that electrophysiological stimulation using the Tsui technique is feasible for epidural catheter positioning in adults with chronic back pain. It may optimize epidural steroid injection in this population. RésuméObjectif Il peut être difficile de déterminer le positionnement du cathéter péridural et de placer de façon précise les corticostéroïdes au site de la lésion chez les adultes souffrant de maux de dos chroniques. La fluoroscopie est considérée comme la norme de soins pour guider le positionnement du cathéter péridural et l'injection subséquente chez les patients recevant des corticostéroïdes par voie péridurale, mais la technique comporte certaines limites. Nous avons émis l'hypothèse que la stimulation électrophysiologique réalisée à l'aide du test de Tsui était faisable pour déterminer le positionnement adéquat du cathéter péridural chez les adultes souffrant de maux de dos Author contributions Niamh McAuliffe made substantial contributions to conception and design, acquisition of data, analysis and interpretation of data; drafted the article and revised the manuscript; and approved the final version to be published. Sharon Pickworth made substantial contributions to conception and design, acquisition of data; revised the manuscript; and approved the final version to be published. Tania DiRenna made substantial contributions to conception and design, acquisition of data; and revised the manuscript;...

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Electrical Stimulation of the Epidural Space Using a Catheter With a Removable Stylet

Cited by 14 publications

References 13 publications

A Randomized Comparison of Loss of Resistance Versus Loss of Resistance Plus Electrical Stimulation: Effect On Success of Thoracic Epidural Placement

A Randomized Comparison of Loss of Resistance Versus Loss of Resistance Plus Electrical Stimulation: Effect On Success of Thoracic Epidural Placement

Epidural electrical stimulation test versus local anesthetic test dose for thoracic epidural catheter placement: a prospective observational study

Electrophysiological stimulation (Tsui test) is feasible for epidural catheter positioning in adults with chronic back pain: a cohort study

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