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:10.1016/j.rapm.2006.10.006

Cited by 13 publications

(15 citation statements)

References 17 publications

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“…By priming the epidural catheter with normal saline, they were able to elicit myotomal contractions in 28 of 39 patients using an average current of 3.78 mA (pulse width = 0.2 millisecond; frequency = 1 Hz). 56 In subsequent studies, different authors set out to assess the reliability of ES for the thoracic and lumbar epidural spaces 30,[56][57][58][59][60] (Table 2). When compared with clinical response (sensory blockade/successful analgesia) or postoperative radiographic assessment of catheter placement, ES confers 80% to 100% sensitivity, 83% to 100% specificity, 96% to 100% positive predictive value, and 16% to 100% negative predictive value.…”

Section: Electrical Stimulationmentioning

confidence: 99%

Confirmation of Loss-of-Resistance for Epidural Analgesia

Tran

González

Bernucci

et al. 2015

Regional Anesthesia and Pain Medicine

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Section: Electrical Stimulationmentioning

confidence: 99%

Confirmation of Loss-of-Resistance for Epidural Analgesia

Tran

González

Bernucci

et al. 2015

Regional Anesthesia and Pain Medicine

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“…The EST is designed not only to confirm the correct location of the epidural catheter, but also to suggest unintentional epidural catheter placement. In this study, the EST was performed as previously described [19] in the epiradicular space. The amount of electrical current applied, and whether an appropriate motor stimulation is generated, is thought to determine where the epidural catheter is located base on 2 parameters.…”

Section: Discussionmentioning

confidence: 99%

“…Charghi et al [19] used an alternative mode of epidural stimulation as we had and epidural stimulation yielded a mean threshold of 1.90 ± 1.80 nC. Of 37 catheters intentionally placed in the epidural space, the mean current required to produce an appropriate palpable motor contraction was 7.8 mA [22].…”

Section: Discussionmentioning

confidence: 99%

Minimum current requirement for confirming the localization of an epiradicular catheter placement

Jeong

Shim

Kim

et al. 2012

Korean J Anesthesiol

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BackgroundBased on the necessity to confirm the epiradicular catheter misplacement, epiradicular threshold current for the confirmation of catheter tip localization is required.MethodsThirty-four adult patients with low extremity radiating pain were to receive epiradicular catheterization at the lumbosacral level. The epidural space was accessed percutaneously in cranial to caudal direction. A metal coil-reinforced epidural catheter was inserted and advanced caudolaterally toward the target neural foramen until the catheter tip was located below the bisection of pedicle. The electrical stimulation was performed after catheter placement in epidural and epiradicular space. Using the constant current nerve stimulator, the stimulating current was increased from 0 to 5 mA (pulse width of 0.3 ms; frequency of 2 Hz) until adequate motor contraction was evident. The threshold current for motor response with epidural space (EDmA) and epiradicular space (ERmA) placement were recorded upon electrical stimulation. In addition, the threshold charge for motor response with epidural (EDnC) and epiradicular (ERnC) placement were recorded.ResultsOf 34 catheters intentionally placed in the epiradicular space, ERmA was 0.53 ± 0.48 mA. The ERnC was significantly lower than EDnC (P < 0.05). The EDmA and ERmA were below 1 mA in 3 patients and above 1 mA in 4 patients, respectively.ConclusionsWe conclude that, threshold current for motor response seems to be lower for epiradicular compared with epidural placement, although we were not able to directly investigate the epidural threshold current. The threshold current of epiradicular space overlap that in the epidural space.

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“…94,95 Interestingly, adjunctive NS can also be used to confirm correct placement of epidural catheters. 96 Although it seems to provide high sensitivity and specificity, 97 further investigation is required to compare conventional and NS-confirmed LOR.…”

Section: Solutionsmentioning

confidence: 99%

Beyond Ultrasound Guidance for Regional Anesthesiology

Tran

Boezaart

Neal

2017

Regional Anesthesia and Pain Medicine

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Despite its popularity, ultrasound (US)-guided regional anesthesiology is associated with significant limitations. The latter can be attributed to either the US machine (ie, decreased ability to insonate deep neural structures, as well as the thoracic spine) or the operator. Shortcomings associated with the operator can be explained by errors in perception (ie, ambiguous criteria for needle/catheter tip-to-nerve proximity and subparaneural local anesthetic injection) or interpretation. Perhaps the greatest confusion afflicting US-guided regional anesthesiology originates from an intellectual misconception pertaining to its application. Increasingly, authors are using US to identify interfascial planes where local anesthetic can be injected thereby "discovering" new truncal blocks. Often these novel blocks suffer from a lack of proper randomized, comparative validation.Fortunately, solutions have been proposed to remedy many shortcomings associated with US guidance. The inability of US to reliably insonate deep neural structures can be circumvented with adjunctive neurostimulation. Fluoroscopy and waveform analysis have been proven to increase the success rate of thoracic epidural blocks. For continuous nerve blocks, combined US-neurostimulation may provide an objective end point (ie, an evoked motor response) for neural proximity and subparaneural positioning of the catheter tip. Finally, the solution to the plethora of nonvalidated US-guided blocks is both elegant and simple. New nerve blocks should answer a specific clinical need, and their first descriptions should take the form of an adequately powered, observer-blinded, randomized comparison against the established standard of care or, at the very least, a large case series (eg, a Brief Technical Report).

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

Abstract: We conclude that the TheraCath, because of the removable stylet, provides effective electrostimulation of the epidural space. Its use was simple and devoid of complications. Nonetheless, further studies are required before implementing its routine use in clinical settings.

Cited by 13 publications

References 17 publications

Confirmation of Loss-of-Resistance for Epidural Analgesia

Confirmation of Loss-of-Resistance for Epidural Analgesia

Minimum current requirement for confirming the localization of an epiradicular catheter placement

Beyond Ultrasound Guidance for Regional Anesthesiology

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