Medizinische Universität Graz Austria/Österreich - Forschungsportal - Medical University of Graz
Gewählte Publikation:
SHR Neuro Krebs Kardio Lipid Stoffw Microb
Heschl, S; Hallmann, B; Zilke, T; Gemes, G; Schoerghuber, M; Auer-Grumbach, M; Quehenberger, F; Lirk, P; Hogan, Q; Rigaud, M.
Diabetic neuropathy increases stimulation threshold during popliteal sciatic nerve block.
Br J Anaesth. 2016; 116(4):538-545
Doi: 10.1093/bja/aew027
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- Führende Autor*innen der Med Uni Graz
- Heschl Stefan
- Rigaud Marcel
- Co-Autor*innen der Med Uni Graz
- Auer-Grumbach Michaela
- Gemes Geza
- Hallmann Barbara
- Quehenberger Franz
- Schörghuber Michael
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- Abstract:
- Peripheral nerve stimulation is commonly used for nerve localization in regional anaesthesia, but recommended stimulation currents of 0.3-0.5 mA do not reliably produce motor activity in the absence of intraneural needle placement. As this may be particularly true in patients with diabetic neuropathy, we examined the stimulation threshold in patients with and without diabetes. Preoperative evaluation included a neurological exam and electroneurography. During ultrasound-guided popliteal sciatic nerve block, we measured the current required to produce motor activity for the tibial and common peroneal nerve in diabetic and non-diabetic patients. Proximity to the nerve was evaluated post-hoc using ultrasound imaging. Average stimulation currents did not differ between diabetic (n=55) and non-diabetic patients (n=52). Although the planned number of patients was not reached, the power goal for the mean stimulation current was met. Subjects with diminished pressure perception showed increased thresholds for the common peroneal nerve (median 1.30 vs. 0.57 mA in subjects with normal perception, P=0.042), as did subjects with decreased pain sensation (1.60 vs. 0.50 mA in subjects with normal sensation, P=0.038). Slowed ulnar nerve conduction velocity predicted elevated mean stimulation current (r=-0.35, P=0.002). Finally, 15 diabetic patients required more than 0.5 mA to evoke a motor response, despite intraneural needle placement (n=4), or required currents ≥2 mA despite needle-nerve contact, vs three such patients (1 intraneural, 2 with ≥2 mA) among non-diabetic patients (P=0.003). These findings suggest that stimulation thresholds of 0.3-0.5 mA may not reliably determine close needle-nerve contact during popliteal sciatic nerve block, particularly in patients with diabetic neuropathy. NCT01488474. © The Author 2016. Published by Oxford University Press on behalf of the British Journal of Anaesthesia.
- Find related publications in this database (using NLM MeSH Indexing)
- Adult -
- Aged -
- Aged, 80 and over -
- Diabetic Neuropathies - physiopathology
- Electric Stimulation -
- Evoked Potentials, Motor - drug effects
- Female -
- Follow-Up Studies -
- Humans -
- Lower Extremity - surgery
- Male -
- Middle Aged -
- Nerve Block - methods
- Neural Conduction - drug effects
- Orthopedic Procedures -
- Pain Perception - drug effects
- Peroneal Nerve - drug effects
- Sciatic Nerve - diagnostic imaging
- Sensory Thresholds -
- Tibial Nerve - drug effects
- Ultrasonography, Interventional -
- Find related publications in this database (Keywords)
- diabetic neuropathies
- nerve block
- peroneal nerve
- tibial nerve