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LETTER TO THE EDITOR

Stimulating Cervical Epidural Catheter

Department of Anesthesiology; McGill University Health Center; Montreal, Quebec, Canada; chansheryi{at}yahoo.com

To the Editor:

Following up on the report by Tamai et al. (1), we wish to report an alternative technique of epidural catheter placement using electrical stimulation in a patient who underwent a left scapulectomy. The scapula receives sensory innervation from the C5-8 nerve roots (2), thus making cervical epidural an attractive option for postoperative analgesia. We identified the epidural space at T1-2 after 2 previous attempts at the C7-T1 level were unsuccessful. As our institution does not have catheters with stainless steel coils or stylets as recommended by Tamai et al. (1), we used the Arrow StimuCath Continuous Nerve Block Procedure Kit (Arrow International, Reading, PA). We ensured cephalic migration of the catheter from the thoracic approach into the cervical region by advancing the catheter until the upper extremity motor response (shoulder abduction) was elicited at an output of 3.1 mA (pulse width = 0.3 ms), as recommended by Tsui et al. (3). Satisfactory postoperative anesthesia was achieved with this technique.

The Arrow StimuCath may be an option for epidural catheter placement under electrical stimulation guidance, but this should be properly investigated before it is widely adopted.

References

1. Tamai H, Sawamura S, Atarashi H, et al. The electrical properties of epidural catheters: what are the requirements for nerve stimulation guidance? Anesth Analg 2005;100:1704–7.[Abstract/Free Full Text]
2. Brown DL. Upper extremity block anatomy. In: Brown, DL, ed. Atlas of regional anesthesia, 2nd ed. Philadelphia: WB Saunders, 1999:18.
3. Tsui BCH, Wagner A, Cave D, Seal R. Threshold current for a insulated epidural needle in pediatric patients. Anesth Analg 2004;99:694–6.[Abstract/Free Full Text]

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