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Elektrische Nervenstimulation bei peripheren Nervenblockaden

Sonographisch gesicherte Kanülenlage und Einfluss einer G5%-Injektion

Electrical nerve stimulation for peripheral nerve blocks

Ultrasound-guided needle positioning and effect of 5% glucose injection

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Zusammenfassung

Hintergrund

Die Nutzung der Nervenstimulation ist ein gängiger Standard bei der Anlage peripherer Nervenblockaden. Zunehmend werden ultraschallgestützte Blockaden durchgeführt. Mit dieser Studie sollte untersucht werden, welcher Zusammenhang zwischen der per Ultraschall gesicherten Kanülenlage und der elektrischen Nervenstimulation vor und nach der Injektion von 5%iger Glukoselösung (G5%) quantifiziert werden kann.

Patienten und Methoden

Nach Genehmigung durch die Ethikkommission wurden 60 Patienten in die Studie aufgenommen; von 51 dieser Teilnehmer konnten die Untersuchungsergebnisse analysiert werden. Bei sonographisch als richtig identifizierter Kanülenlage wurde die niedrigste Stromstärke, die zum Auftreten der erwarteten motorischen Antwort führte, vor und nach Injektion von 1 ml G5% ermittelt.

Ergebnisse

Bei 76% der Patienten ließen sich die Nervenstrukturen gut visualisieren. Es waren 90% der Blockaden erfolgreich. Nur 29% der Patienten mit erfolgreicher Blockade wiesen eine motorische Antwort bei einer Stimulation ≤0,5 mA auf. Es zeigte sich lediglich ein Zusammenhang zwischen der Qualität der Visualisierung und dem Blockadeerfolg. Eine signifikante Veränderung der Stimulationsschwelle durch G5% konnte nicht belegt werden.

Schlussfolgerung

Unter dem verwendeten Protokoll hängt der Erfolg einer Blockade lediglich von der Qualität der Visualisierung ab. Die elektrische Information über die Kanülenspitze scheint bei sonographisch korrekter Verteilungsbeurteilung des Lokalanästhetikums zweifelhaft.

Abstract

Background

The use of nerve stimulation is a common standard procedure for peripheral nerve blocks. However, ultrasound guidance is increasingly being used as an alternative. This study explored the relationship between needle positioning defined by ultrasound guidance and the electrical nerve stimulation before and after injection of 5% glucose solution (G5%).

Patients and methods

After obtaining permission from the ethics committee, 60 patients were enrolled in the study and the results from 51 patients could be analyzed. For sonographically defined correct needle placement the lowest electrical threshold of the elicited motor responses before and after injection of 1 ml G5% was determined.

Results

In 76% of cases nerve structures could be visualized with high quality and 90% of the blocks were successful. Only 29% of patients with a successful block showed a motor response with a stimulation current ≤0.5 mA. There was a relationship only between the quality of the visualization and the success of the blockade. Addition of G5% did not result in significant changes in stimulation thresholds.

Conclusion

With the protocol used the success of a blockade depends only on the quality of visualization. With correct ultrasound-guided needle tip positioning the electrical information seems to be skewed and doubtful.

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Authors and Affiliations

  1. Universitätsklinik für Anästhesiologie und operative Intensivmedizin, Campus Charité Mitte, Charité – Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Deutschland

    M. Habicher, M. Ocken, J. Birnbaum &  T. Volk

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  1. M. Habicher
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  2. M. Ocken
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  3. J. Birnbaum
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  4. T. Volk
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Correspondence to T. Volk.

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Habicher, M., Ocken, M., Birnbaum, J. et al. Elektrische Nervenstimulation bei peripheren Nervenblockaden. Anaesthesist 58, 986–991 (2009). https://doi.org/10.1007/s00101-009-1587-z

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  • DOI: https://doi.org/10.1007/s00101-009-1587-z

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