• Xavier Capdevila, Sandrine Lopez, Nathalie Bernard, Christophe Dadure, Frédéric Motais, Philippe Biboulet, and Olivier Choquet.
• Department of Anesthesia and Critical Care Medicine, Lapeyronie University Hospital, Avenue du Doyen Giraud, 34295 Montpellier Cedex 5, France. x-capdevila@chu-montpellier.fr
• Reg Anesth Pain Med. 2004 May 1; 29 (3): 206-11.

Background And ObjectivesShort reports have noted that percutaneous prelocation is helpful in determining the anatomic course of a peripheral nerve, and, thereby, may serve as a guide for block needle insertion. We prospectively studied percutaneous electrode guidance to assist axillary brachial plexus blocks.MethodsIn 131 consecutive patients, the tip of an insulated needle emitting 5 mA was placed on the skin above and below the axillary artery to obtain a hand motor response characteristic of the median, ulnar, and radial nerves in succession. The current was reduced until all movement had ceased. The needle was then inserted toward the nerve to be blocked, decreasing the intensity from 2 mA to 0.5 mA, so that the same selected motor response was still obtained. The length of the needle inserted was noted, and 1.5% lidocaine was injected. Pain verbal analogic score (VAS) values were noted during both procedures. Complete sensory blockade was evaluated at 30 min.ResultsRates of successful percutaneous electrode guidance were 94.6% for the median nerve, 89.4% for the radial nerve, 88.5% for the ulnar nerve, and 85.5% for all 3 nerves together. A significant correlation was found between the lowest percutaneous current applied and the depth of the nerve stimulated at 0.5 mA. Pain VAS values were significantly lower during percutaneous stimulation than during needle insertion (P <.05). Sensory block for all 3 nerves was noted in 92% of patients.ConclusionsPercutaneous electrode guidance using the insulated needle enabled clinicians to locate the terminal branches of the plexus in the axilla and appreciate their depth. This method could, therefore, minimize patient discomfort and perhaps the risk of nerve trauma.

21 keywords...

hide…