title: Guidance of block needle insertion by electrical nerve stimulation: a pilot study of the resulting distribution of injected solution in dogs.
abstract: BACKGROUND
  Little is known regarding the final needle tip location when various intensities of nerve stimulation are used to guide block needle insertion. Therefore, in control and hyperglycemic dogs, the authors examined whether lower-intensity stimulation results in injection closer to the sciatic nerve than higher-threshold stimulation.
  
  
  METHODS
  During anesthesia, the sciatic nerve was approached with an insulated nerve block needle emitting either 1 mA (high-current group, n = 9) or 0.5 mA (low-current group, n = 9 in control dogs and n = 6 in hyperglycemic dogs). After positioning to obtain a distal motor response, the lowest current producing a response was identified, and ink (0.5 ml) was injected. Frozen sections of the tissue revealed whether the ink was in contact with the epineurium of the nerve, distant to it, or within it.
  
  
  RESULTS
  In control dogs, the patterns of distribution using high-threshold (final current 0.99 +/- 0.03 mA, mean +/- SD) and low-threshold (final current 0.33 +/- 0.08 mA) stimulation equally showed ink that was in contact with the epineurium or distant to it. One needle placement in the high-threshold group resulted in intraneural injection. In hyperglycemic dogs, all needle insertions used a low-threshold technique (n = 6, final threshold 0.35 +/- 0.08 mA), and all resulted in intraneural injections.
  
  
  CONCLUSIONS
  In normal dogs, current stimulation levels in the range of 0.33-1.0 mA result in needle placement comparably close to the sciatic nerve but do not correlate with distance from the target nerve. In this experimental design, low-threshold electrical stimulation does not offer satisfactory protection against intraneural injection in the presence of hyperglycemia.
authors: Department of Anesthesiology, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, Wisconsin 53226, USA.
authors: Marcel
authors: M
authors: Rigaud
authors: Patrick
authors: P
authors: Filip
authors: Philipp
authors: P
authors: Lirk
authors: Andreas
authors: A
authors: Fuchs
authors: Geza
authors: G
authors: Gemes
authors: Quinn
authors: Q
authors: Hogan
mesh_terms: D000818:Animals; D004396:Coloring Agents / Q000008:administration & dosage* / Q000493:pharmacokinetics; D004195:Disease Models, Animal; D004285:Dogs; D004558:Electric Stimulation / Q000379:methods*; D006943:Hyperglycemia / Q000503:physiopathology*; D023421:Models, Animal; D009339:Needles; D010525:Peripheral Nerves / Q000502:physiology / Q000503:physiopathology; D010865:Pilot Projects; D011897:Random Allocation; D012584:Sciatic Nerve / Q000502:physiology / Q000503:physiopathology*
chemical_list: D004396:Coloring Agents