title: Intraoperative electrophysiological studies to predict the efficacy of neurolysis after nerve injury-experiment in rats.
abstract: Compound muscle action potentials (CMAPs) can be used to analyze injury and recovery of nerve. This standardized study evaluates the value of CMAP analysis in predicting the long-term efficacy of neurolysis. CMAP amplitude is also used to determine the optimal extent of neurolysis. The left peroneal nerves of 30 rats were crushed. CMAPs were recorded for both crushed (left) and control (right) nerves. Fifteen rats underwent neurolysis 3 months post crush injury; the remaining 15 were sham controls and did not undergo neurolysis. CMAP measurements were taken after: (1) release of the nerve from the fascia, (2) opening the epineurium, and (3) opening the perineurium. At 3 months post crush injury, opening the epineurium resulted in a statistically significant increase in CMAP. CMAP increase with perineurial neurolysis was greater than with fascial release of the nerve but was not statistically different from that of epineurial release. At 5 months post crush injury, recovery of crushed nerves that underwent neurolysis was 90% and significantly less at 70.5% in rats not treated with neurolysis, according to CMAP analysis. Two conclusions can be made from this study. First, intraoperative neurophysiologic studies can monitor the immediate results of neurolysis and predict long-term results in the injured nerve. Second, epineurotomy is important in neurolysis, improves the function of the nerve, less invasive, and a slightly more effective technique than perineurotomy.
authors.affiliation: Department of Plastic Surgery, Medical College of Wisconsin, 8700 Watertown Plank Road, Milwaukee, WI, 53226, USA.
authors.forename: Ji-Geng
authors.initials: JG
authors.lastname: Yan
authors.forename: Mary P
authors.initials: MP
authors.lastname: Eldridge
authors.forename: William W
authors.initials: WW
authors.lastname: Dzwierzynski
authors.forename: Yu Hui
authors.initials: YH
authors.lastname: Yan
authors.forename: Safwan
authors.initials: S
authors.lastname: Jaradeh
authors.forename: Lin-Ling
authors.initials: LL
authors.lastname: Zhang
authors.forename: James R
authors.initials: JR
authors.lastname: Sanger
authors.forename: Hani S
authors.initials: HS
authors.lastname: Matloub
references.citation: Muscle Nerve. 1982 Feb;5(2):162-5
references.pmid: 6280043
references.citation: Muscle Nerve. 1991 Mar;14(3):237-44
references.pmid: 1645845
references.citation: Electromyogr Clin Neurophysiol. 2000 Jan-Feb;40(1):61-3
references.pmid: 10782360
references.citation: J Neurol Neurosurg Psychiatry. 1976 Jul;39(7):615-26
references.pmid: 993794
references.citation: Acta Neuropathol. 1973 Jul 11;25(2):120-6
references.pmid: 4727736
references.citation: Orthop Clin North Am. 1988 Jan;19(1):57-69
references.pmid: 3275929
references.citation: Hand Clin. 2000 Feb;16(1):25-36
references.pmid: 10696574
references.citation: Am J Orthop (Belle Mead NJ). 2003 Jan;32(1):14-6
references.pmid: 12580345
references.citation: Plast Reconstr Surg. 2001 Apr 15;107(5):1183-9
references.pmid: 11373559
references.citation: Hand Clin. 2000 Feb;16(1):53-66, viii
references.pmid: 10696576
references.citation: Can Anaesth Soc J. 1975 May;22(3):253-64
references.pmid: 1139370
references.citation: Hand Clin. 1995 Nov;11(4):555-61
references.pmid: 8567738
references.citation: Acta Neuropathol. 1966 Sep 1;7(1):1-15
references.pmid: 5971099
references.citation: Hand Clin. 1992 May;8(2):201-14
references.pmid: 1613029
references.citation: Eur Neurol. 1987;26(3):189-92
references.pmid: 3569373
references.citation: Mil Med. 2000 Mar;165(3):240-2
references.pmid: 10741091
references.citation: AJNR Am J Neuroradiol. 2005 Apr;26(4):973-80
references.pmid: 15814956
references.citation: Am J Phys Med Rehabil. 1990 Dec;69(6):318-22
references.pmid: 2176087
references.citation: Acta Neurochir (Wien). 1991;110(1-2):44-8
references.pmid: 1882718
references.citation: Neurosurgery. 1996 Aug;39(2):312-9; discussion 319-20
references.pmid: 8832668
references.citation: Hand Clin. 2000 Feb;16(1):1-12, vii
references.pmid: 10696572
references.citation: Clin Neurosurg. 1977;24:425-55
references.pmid: 338232
references.citation: Arch Phys Med Rehabil. 1988 Jun;69(6):410-4
references.pmid: 3377665
references.citation: J Neurol Neurosurg Psychiatry. 1974 Nov;37(11):1202-13
references.pmid: 4376162
references.citation: J Neurol Neurosurg Psychiatry. 1983 Dec;46(12):1119-24
references.pmid: 6663311
references.citation: Orthop Clin North Am. 1988 Jan;19(1):13-25
references.pmid: 2827087
references.citation: J Neurol Neurosurg Psychiatry. 1980 Mar;43(3):272-80
references.pmid: 7373325
references.citation: Neurosurgery. 2004 Jun;54(6):1421-8; discussion 1428-9
references.pmid: 15157299