Venous Thromboprophylaxis With Neuromuscular Stimulation: Is It Calf Muscle Pumping or Just Twitches and Jerks?

Abstract

The common peroneal nerve stimulator (CPNS) is a UK-approved device for reducing venous thromboembolism risk. It resembles a wrist watch and is placed over the common peroneal nerve to fire at 1 electrical impulse/sec. The aim was to quantify the claim that it drives the venous muscle pump and imitates walking. Twelve healthy volunteers performed 10 tip-toe maneuvers and 10 ankle dorsiflexions to imitate walking movements. The reductions in calf volume were recorded using air plethysmography (APG). The common peroneal nerve was stimulated for over 10 seconds at each of the 7 increasing electrical impulse settings, and the volume reductions were measured for comparison. The results are expressed as median (interquartile range) absolute (mL), and percentage reduction in calf volume. Tip-toe and dorsiflexion pumping maneuvers were not significantly different: 59 (33.6-96.1), 81.9% vs 51.4 (34-68.5), 59.7%, respectively ( P = .53). However, they both outperformed the CPNS: 10.8 (7.3-18), 13.2% at P = .002 and P = .002, respectively. Qualitatively, the CPNS registered on the tracings as a small spike (muscle twitch) at low settings, with larger amplitudes (ankle jerk) at higher settings. The CPNS activity spikes were discrete, lasting a median (range) of 0.24 (0.16- .3) seconds. The claim that the CPNS empties veins by pumping is supported statistically. However, the amount is small versus the tip-toe and dorsiflexion maneuvers. Furthermore, the CPNS has a short activity profile on the APG trace. Innovations that produce sustained contraction and involve the posterior calf compartments may improve pumping.

Effects on venous flow of transcutaneous electrical stimulation, neuromuscular stimulation, and sham stimulation on soleus muscle: A randomized crossover study in healthy subjects

“…[ 17 ] However, due to its nature, TENS provokes twitches to jerks (0.24 seconds of median duration), depending on the amplitude applied, low or high, respectively. [ 28 ] In the current research, NMES has a longer contraction time than TENS, to trigger a sustained contraction to ankle flexion. However, NMES was delivered employing an off-time of 10 seconds, 5 times higher than the on-time.…”

“…TENS at common peroneal nerve activates calf muscles by passive stretch [ 27 ] but powerful muscles of the calf are poorly stimulated compared to active tip-toe and dorsiflexion maneuvers. [ 28 ] Moreover, when comparing TENS on common peroneal nerve versus soleus motor points, the latter was preferred in terms of tolerance of high amplitudes. [ 17 ] However, due to its nature, TENS provokes twitches to jerks (0.24 seconds of median duration), depending on the amplitude applied, low or high, respectively.…”

“…TENS at common peroneal nerve activates calf muscles by passive stretch [27] but powerful muscles of the calf are poorly stimulated compared to active tip-toe and dorsiflexion maneuvers. [28] Moreover, when comparing TENS on common peroneal nerve versus soleus motor points, the latter was preferred in terms of tolerance of Table 3 Maximum tolerated intensity and discomfort ratings (VAS and) after finishing the placebo, NMES, and TENS.…”

Research quality in the study of mechanical methods of deep vein thrombosis prophylaxis

“…Comparing the peak velocities produced by one device that compresses once a minute, and another that causes the muscle to contract once a second has no value, as they cannot be moving similar amounts of blood. So, while the acute physiological effects of a device can be established, 3,56,71 in the absence of a significant body of clinical data from that device it is very difficult to infer any capacity to affect DVT rates.…”