title: Prospective comparison of continuous femoral nerve block with nonstimulating catheter placement versus stimulating catheter-guided perineural placement in volunteers.
abstract: OBJECTIVE
  Stimulating catheter-guided perineural placement may potentially increase the success rate and quality of continuous femoral nerve block as compared with a nonstimulating catheter technique. These hypotheses have not been rigorously tested.
  
  
  METHODS
  Twenty volunteers underwent placement of bilateral femoral nerve catheters in this prospective, randomized, double-blind study. For each side, a stimulating needle was advanced until quadriceps contractions were obtained at < or =0.5 mA. On one side, a stimulating catheter was advanced 4 to 5 cm beyond the needle tip while eliciting quadriceps contractions via the catheter. If quadriceps contractions decreased or disappeared, the catheter position was adjusted until quadriceps contractions could be elicited at < or =0.5 mA. On the contralateral side, an identical catheter was advanced 4 to 5 cm beyond the needle tip without attempts to elicit quadriceps contractions via the catheter. After bolus injection of 10 mL lidocaine 1%, ropivacaine 0.2% at 10 mL/h was continuously infused through both catheters for 4 hours. Success of femoral block was defined as loss of sensation to cold and pinprick stimuli. Quality of successful block was determined by tolerance to transcutaneous electrical stimulation and force dynamometry of quadriceps strength.
  
  
  RESULTS
  Block success was 100% via the stimulating catheters versus 85% via the nonstimulating catheters (P =.07). Overall tolerance to transcutaneous electrical stimulation (P =.009) and overall depth of motor block (P =.03) was significantly higher in the stimulating catheter-guided femoral nerve blocks.
  
  
  CONCLUSIONS
  In this volunteer study, there was no statistically significant difference in block success between the two techniques. However, stimulating catheter-guided placement provided an increased overall quality of continuous femoral perineural blockade. Further studies are needed to verify these observations in the clinical setting.
authors.affiliation: Department of Anesthesiology, Virginia Mason Medical Center, 1100 9th Avenue, B2-AN, Seattle, WA 98101, USA. anefvs@vmmc.org
authors.forename: Francis V
authors.initials: FV
authors.lastname: Salinas
authors.forename: Joseph M
authors.initials: JM
authors.lastname: Neal
authors.forename: Lila A
authors.initials: LA
authors.lastname: Sueda
authors.forename: Dan J
authors.initials: DJ
authors.lastname: Kopacz
authors.forename: Spencer S
authors.initials: SS
authors.lastname: Liu
mesh_terms: D000293:Adolescent; D000328:Adult; D001340:Autonomic Nerve Block / Q000295:instrumentation* / Q000379:methods*; D002404:Catheterization / Q000295:instrumentation* / Q000379:methods*; D004311:Double-Blind Method; D005260:Female; D005267:Femoral Nerve / Q000502:physiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies