title: Ultrasound controlled nerve stimulation in the elbow region: high currents and short distances needed to obtain motor responses.
abstract: BACKGROUND
  Electrical nerve stimulation is commonly used to perform peripheral nerve blocks. The purpose of this study was to investigate the relation between stimulating currents and the distance between the needle-tip and stimulated nerves.
  
  
  METHODS
  In 18 volunteers the radial and ulnar nerves were stimulated in the elbow region from opposite directions. Needle-to-nerve distances were measured by high-frequency ultrasound when motor responses to electrical stimulation were elicited with currents of 5, 2, 1 and 0.5 mA and impulse widths of 0.1 ms. Additionally, current thresholds for nerve stimulation were identified when the needle-tip was in contact with the nerve.
  
  
  RESULTS
  The ulnar nerves responded to electrical stimulation from a significantly greater distance than the radial nerves. Threshold levels at needle-to-nerve contact ranged from 0.4 to 4.5 mA for the radial nerve and from 0.32 to 2.0 mA for the ulnar nerve. They were significantly lower for the ulnar nerve than for the radial nerve. Currents required to obtain neuromuscular responses often exceeded the recommended current levels for nerve stimulation.
  
  
  CONCLUSIONS
  Our results show significant differences in the ease of stimulation between the radial and ulnar nerves. High current thresholds and short nerve-to-needle distances were often needed to obtain neuromuscular responses in two nerves in the elbow region.
authors.affiliation: Department of Anesthesiology, Faculty Division Rikshospitalet, University of Oslo, Oslo, Norway. sauter@start.no
authors.forename: A R
authors.initials: AR
authors.lastname: Sauter
authors.forename: M S
authors.initials: MS
authors.lastname: Dodgson
authors.forename: A
authors.initials: A
authors.lastname: Stubhaug
authors.forename: M
authors.initials: M
authors.lastname: Cvancarova
authors.forename: O
authors.initials: O
authors.lastname: Klaastad
mesh_terms: D000328:Adult; D004550:Elbow / Q000000981:diagnostic imaging* / Q000294:innervation*; D004558:Electric Stimulation; D005260:Female; D006801:Humans; D008297:Male; D009119:Muscle Contraction / Q000502:physiology; D018482:Muscle, Skeletal / Q000502:physiology*; D009339:Needles; D011826:Radial Nerve / Q000502:physiology; D014459:Ulnar Nerve / Q000502:physiology; D014463:Ultrasonography