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Anesth Analg 2006;103:761-767
© 2006 International Anesthesia Research Society
doi: 10.1213/01.ane.0000229705.45270.0f

ANALGESIA

Nerve Localization Techniques for Interscalene Brachial Plexus Blockade: A Prospective, Randomized Comparison of Mechanical Paresthesia Versus Electrical Stimulation

Gregory A. Liguori, MD, Victor M. Zayas, MD, Jacques T. YaDeau, MD, PhD, Richard L. Kahn, MD, Leonardo Paroli, MD, PhD, Valeria Buschiazzo, and Anita Wu, MD

From the Hospital for Special Surgery, Department of Anesthesiology Weill Medical College of Cornell University, New York, New York.

Address correspondence to Gregory A. Liguori, MD, Hospital for Special Surgery, Weill Medical College of Cornell University, Anesthesiology Department, 535 East 70th Street, Room 636W, New York, NY 10021. Address e-mail to liguorig{at}hss.edu.

Abstract

Postoperative neurologic symptoms (PONS) are relatively common after upper extremity orthopedic surgery performed under peripheral neural blockade. In this study, we prospectively compared the incidence of PONS after shoulder surgery under interscalene (IS) block using the electrical stimulation (ES) or mechanical paresthesia (MP) techniques of nerve localization. For patients randomized to the MP group, a 1-in, 23-g long-beveled needle was placed into the IS groove to elicit a paresthesia to the shoulder, arm, elbow, wrist, or hand. For patients randomized to the ES group, a 5-cm, 22-g short-beveled insulated needle was placed into the IS groove to elicit a motor response including flexion or extension of the elbow, wrist, or fingers or deltoid muscle stimulation at a current between 0.2 and 0.5 mA. Each IS block was performed with 50–60 mL of 1.5% mepivacaine containing 1:300,000 epinephrine and 0.1meq/L sodium bicarbonate. Two-hundred-eighteen patients were randomized between the two groups. One patient was lost to follow-up. Twenty-five patients (23%) in the ES group experienced paresthesia during needle insertion. The incidence of PONS using the ES technique was 10.1% (11/109), whereas the incidence with the MP technique was 9.3% (10/108) (not significant). The PONS lasted a median duration of 2 mo, and symptoms in all patients resolved within 12 mo. The success rate, onset time, and patient satisfaction were also comparable between groups. We conclude that the choice of nerve localization technique can be made based on the patient’s and anesthesiologist’s comfort and preferences and not on concern for the development of PONS.




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Lippincott, Williams & Wilkins 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 HighWire Press
Copyright © 2006 by the International Anesthesia Research Society.