title: Compound motor action potential recording distinguishes differential onset of motor block of the obturator nerve in response to etidocaine or bupivacaine.
abstract: The purpose of this investigation was to establish an objective (quantitative) method for determining onset time of motor block induced by different local anesthetics. Twenty-four consenting patients undergoing transurethral surgery during spinal anesthesia were randomized to receive direct obturator nerve block with 10 mL of plain bupivacaine 0.5% (n = 12) or 10 mL of plain etidocaine 1% (n = 12). Another 14 patients (control group) received obturator nerve "block" with saline. After identification of the obturator nerve, patients underwent testing of nerve conduction by recording compound motor action potentials (CMAPs) of thigh adductor muscles in response to stimulation provided by a nerve stimulator at 0.2 to 0.5-mA currents. Testing ended when CMAP amplitudes had returned to their baseline values (control group) or when motor blockade was 90% complete (local anesthetic groups). In all 38 patients, the amplitude of the thigh CMAPs decreased immediately after injection of saline or local anesthetic. While CMAP amplitudes in the control group returned to their initial (baseline) values after 3-6 min, the patients receiving etidocaine or bupivacaine achieved > or = 90% motor blockade after 6 and 13 min, respectively. In the present report, the time to > or = 90% block was significantly faster in patients given etidocaine compared with those given bupivacaine. We conclude that electromyographic recording of CMAPs can be used to compare the ability of different local anesthetics to induce motor block.
authors.affiliation: Department of Anesthesiology, Yale University School of Medicine, New Haven, Connecticut 06510, USA.
authors.forename: P G
authors.initials: PG
authors.lastname: Atanassoff
authors.forename: B M
authors.initials: BM
authors.lastname: Weiss
authors.forename: S J
authors.initials: SJ
authors.lastname: Brull
authors.forename: A
authors.initials: A
authors.lastname: Horst
authors.forename: D
authors.initials: D
authors.lastname: Külling
authors.forename: R
authors.initials: R
authors.lastname: Stein
authors.forename: I
authors.initials: I
authors.lastname: Theiler
mesh_terms: D000328:Adult; D000775:Anesthesia, Spinal; D000779:Anesthetics, Local / Q000008:administration & dosage* / Q000494:pharmacology; D002045:Bupivacaine / Q000008:administration & dosage* / Q000494:pharmacology; D005041:Etidocaine / Q000008:administration & dosage* / Q000494:pharmacology; D019054:Evoked Potentials, Motor; D005260:Female; D006801:Humans; D007866:Leg / Q000294:innervation*; D008297:Male; D009407:Nerve Block; D009431:Neural Conduction / Q000187:drug effects
chemical_list: D000779:Anesthetics, Local; D005041:Etidocaine; D002045:Bupivacaine