• Reg Anesth Pain Med · Jul 2009

    Multicenter Study

    Various possible positions of conventional catheters around the femoral nerve revealed by neurostimulation.

    • Charles Pham Dang, Christel Difalco, Jérôme Guilley, Guillaume Venet, Philippe Hauet, and Corinne Lejus.
    • Pôle Anesthésie-Réanimations, Hôtel-Dieu, F-44093 Nantes cedex, France. charles.phamdang@chu-nantes.fr
    • Reg Anesth Pain Med. 2009 Jul 1;34(4):285-9.

    Background And ObjectivesIn continuous femoral nerve blocks, the various perineural positions of the tip of a conventional catheter and their clinical implication are not completely known.We used stimulating catheters to explore the relationship of catheter tip to nerve.MethodsAmerican Society of Anesthesiologists physical status IYII patients scheduled for total knee arthroplasty were administered effective single-shot blocks of the obturator and sciatic nerves using ropivacaine 0.5% 10 and 20 mL, respectively. Continuous femoral blocks were performed using stimulating catheters, which were advanced blindly. Neurostimulation via catheter was performed but was masked from the investigators' sight. Before general anesthesia was induced for surgery, 5 mL of ropivacaine 0.2% was administered through the femoral nerve catheter, followed by infusion (5 mL/hr). Visual analog scale (VAS) score at rest was recorded on admission to the postanesthesia care unit. Characteristics of neurostimulation via the catheters were analyzed.ResultsThirty-three patients were studied. Motor responses to stimulation via the catheters were obtained at 1 mA or less in 55% of patients and at greater than 1 mA in 45%. Various motor responses involved twitches of the pectineus (12%), sartorius (18%), or quadriceps (48%) muscles, or no muscular twitch up to 5 mA (22%). Catheter-induced motor response at 1 mA or less was associated with median values of VAS scores lower than those at greater than 1 mA (0 vs 30 mm; P = 0.008).ConclusionThe effectiveness of a continuous femoral block depends on neurostimulation characteristics, which likely correspond to various possible catheter tip positions. Conventional catheters provide no information on this issue. These results suggest that better VAS scores are attainable by placing catheters with neurostimulation guidance.

      Pubmed     Full text   Copy Citation     Plaintext  

      Add institutional full text...

    Notes

     
    Knowledge, pearl, summary or comment to share?
    300 characters remaining
    help        
    You can also include formatting, links, images and footnotes in your notes
    • Simple formatting can be added to notes, such as *italics*, _underline_ or **bold**.
    • Superscript can be denoted by <sup>text</sup> and subscript <sub>text</sub>.
    • Numbered or bulleted lists can be created using either numbered lines 1. 2. 3., hyphens - or asterisks *.
    • Links can be included with: [my link to pubmed](http://pubmed.com)
    • Images can be included with: ![alt text](https://bestmedicaljournal.com/study_graph.jpg "Image Title Text")
    • For footnotes use [^1](This is a footnote.) inline.
    • Or use an inline reference [^1] to refer to a longer footnote elseweher in the document [^1]: This is a long footnote..

    hide…