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PEDIATRIC ANESTHESIA

The Use of Electrical Stimulation to Monitor Epidural Needle Advancement in a Porcine Model

Ban C. H. Tsui, MD, MSc, FRCP(C)^*, Derek Emery, MD, FRCP(C), Richard R. E. Uwiera, DVM, PhD, and Brendan Finucane, MB, ChB, FRCP(C)^*

Departments of *Anesthesiology and Pain Medicine, Radiology and Diagnostic Imaging, and Health Sciences Laboratory Animal Services, University of Alberta, Edmonton, Canada

Address correspondence and reprint requests to Ban C. H. Tsui, MSC, MD, FRCP(C), Department of Anesthesiology and Pain Med, 8-120 Clinical Sciences Building, University of Alberta, Edmonton, Alberta, Canada T6G 2G3. Address e-mail to btsui{at}ualberta.ca.

Muscle twitches elicited with electrical stimulation (ES) during epidural insertion may indicate epidural needle location. We examined the potential application of ES at 5 mA as a continuous method of monitoring the response to epidural needle advancement in a porcine model. Five 20-kg pigs were used in this study. A needle with a stimulating current of 5 mA was inserted at 20 separate levels in each pig. The needle was advanced until a muscle twitch was observed without loss-of-resistance (LOR). The needle position was then assessed using LOR. At the end of the experiment, an autopsy was performed to assess the spinal cord for injury. A total of 100 needle insertions were performed in the 5 pigs. The threshold current in the epidural space was 3.6 ± 0.6 mA. In 59 of the needle insertions, LOR was not obtained at the depth at which a muscle twitch was initially observed. However, after advancing these 59 needles another 1–2 mm, LOR was obtained. In the other 41 insertions, LOR was observed without further advancement of the needle. Autopsies indicated there were no dural punctures or spinal cord damage in any of the pigs. These observations suggest that ES can be used to signal that the epidural needle is in or approaching the epidural space. However, the high false positive predictive value (59%) makes it impractical and unreliable to detect the precise entry of a needle into the epidural space in pigs.

This article has been cited by other articles:

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Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins with the assistance of Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999