Systematic evaluation of the highest current threshold for regional anaesthesia in a porcine model

• Published in: Acta anaesthesiologica Scandinavica 2010-07, Vol.54 (6), p.770-776
• Main Authors: STEINFELDT, T., GRAF, J., VASSILIOU, T., NIMPHIUS, W., STURM, K., KILL, C., WIESMANN, T., WULF, H., MÜLLER, H.-H.
• Format: Article
• Language: English
• Subjects: Anesthesia; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Animals; Axilla; Biological and medical sciences; Brachial Plexus - physiology; Brachial Plexus - ultrastructure; Catheterization; Electric Stimulation - methods; Electrodes, Implanted; Electromagnetic Phenomena; Extremities - innervation; Female; Femoral Nerve - physiology; Femoral Nerve - ultrastructure; Groin; Medical sciences; Muscle Contraction; Nerve Block - methods; Peripheral Nerves - ultrastructure; Single-Blind Method; Sus scrofa; Swine
• ISSN: 0001-5172; 1399-6576
• DOI: 10.1111/j.1399-6576.2010.02235.x

Background: The purpose of this study was to determine systematically the highest minimal stimulation current threshold for regional anaesthesia in pigs. Methods: In an established pig model for regional anaesthesia, needle placements applying electric nerve stimulation were performed. The primary outcome was the frequency of close needle to nerve placements as assessed by resin injectates and subsequent anatomical evaluation. Following a statistical model (continual reassessment method), the applied output currents were selected to limit the necessary number of punctures, while providing guidance towards the highest output current range. Results: Altogether 186 punctures were performed in 11 pigs. Within the range of 0.3–1.4 mA, no distant needle to nerve placement was found. In the range of 1.5–4.1 mA, 43 distant needle to nerve placements occurred. The range of 1.2–1.4 mA was the highest interval that resulted in a close needle to nerve placement rate of ≥95%. Conclusions: In the range of 0.3–1.4 mA, all resin deposition was found to be adjacent to nerve epineurium. The application of minimal current intensities up to 1.4 mA does not obviously lead to a reduction of epineural injectate contacts in pigs. These findings suggest that stimulation current thresholds up to 1.4 mA result in equivalent needle tip localisation in pigs.