Electrical impedance to detect accidental nerve puncture during ultrasound-guided peripheral nerve blocks

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• 作者：Patrick Bardou MD (1)
  Jean-Christophe Merle MD (1)
  Jean-Baptiste Woillard PharmD (2)
  Nathalie Nathan-Denizot PhD (1)
  Pierre Beaulieu PhD (1)
  
• 刊名：Canadian Journal of Anesthesia/Journal canadien d'anesth篓娄sie
• 出版年：2013
• 出版时间：March 2013
• 年：2013
• 卷：60
• 期：3
• 页码：253-258
• 全文大小：328KB
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• 作者单位：Patrick Bardou MD (1)
  Jean-Christophe Merle MD (1)
  Jean-Baptiste Woillard PharmD (2)
  Nathalie Nathan-Denizot PhD (1)
  Pierre Beaulieu PhD (1)
  
  1. Department of Anesthesiology, Limoges University Hospital Center, CHU Limoges, 2 avenue Martin Luther King, 87042, Limoges Cedex, France
  2. Department of Pharmacology and Toxicology, CHU Limoges, Limoges, France
  

文摘

Purpose The objective of this study was to assess if an increase in electrical impedance was associated with intraneural (sub-epineural) needle tip placement. Methods Two electrical impedance measurements were carried out in each of 140 peripheral nerve blocks. The first measurement was performed at a distance of 0.5-1?cm from the nerve trunk (reference value), and the second measurement was performed close to the nerve, either immediately before local anesthetic injection if no nerve puncture was suspected, or immediately before repositioning the needle if nerve puncture was suspected. Nerve puncture was suspected if any one of the following indications was present: pain or paresthesia; motor responses with a minimal stimulating current?<?0.4?mA; needle tip observed inside the nerve using ultrasound; nerve swelling after injection of local anesthetic. Electrical impedance variations were compared between the no puncture and the suspected puncture groups. Results Nerve puncture was suspected in 21 cases. The median variation [quartiles] of electrical impedance was +6.6% [?0; 36%] in the suspected puncture group (n?=?21) and ?0.0% [?8; 0%] in the no puncture group (n?=?119) (P?=?0.02). Absolute values of electrical impedance close to the nerve were greater in the suspected puncture group (15.5?kΩ [12.0; 18.0?kΩ]) vs the no puncture group (12.0?kΩ [8.9; 15.1% kΩ]) (P?=?0.013). A receiver operating characteristic (ROC) curve was constructed, and the optimal cut-off for impedance was +4.3%. Conclusion A?>?4.3% increase in electrical impedance may indicate accidental nerve puncture during peripheral nerve block.