title: Systematic evaluation of the highest current threshold for regional anaesthesia in a porcine model.
abstract: BACKGROUND
  The purpose of this study was to determine systematically the highest minimal stimulation current threshold for regional anaesthesia in pigs.
  
  
  METHODS
  In an established pig model for regional anaesthesia, needle placements applying electric nerve stimulation were performed. The primary outcome was the frequency of close needle to nerve placements as assessed by resin injects and subsequent anatomical evaluation. Following a statistical model (continual reassessment method), the applied output currents were selected to limit the necessary number of punctures, while providing guidance towards the highest output current range.
  
  
  RESULTS
  Altogether 186 punctures were performed in 11 pigs. Within the range of 0.3-1.4 mA, no distant needle to nerve placement was found. In the range of 1.5-4.1 mA, 43 distant needle to nerve placements occurred. The range of 1.2-1.4 mA was the highest interval that resulted in a close needle to nerve placement rate of > or =95%.
  
  
  CONCLUSIONS
  In the range of 0.3-1.4 mA, all resin deposition was found to be adjacent to nerve epineurium. The application of minimal current intensities up to 1.4 mA does not obviously lead to a reduction of epineural injectate contacts in pigs. These findings suggest that stimulation current thresholds up to 1.4 mA result in equivalent needle tip localisation in pigs.
authors.affiliation: Department of Anaesthesiology and Intensive Care Therapy, Philipps-University Marburg, Marburg, Germany. steinfeldt@gmx.de
authors.forename: T
authors.initials: T
authors.lastname: Steinfeldt
authors.forename: J
authors.initials: J
authors.lastname: Graf
authors.forename: T
authors.initials: T
authors.lastname: Vassiliou
authors.forename: W
authors.initials: W
authors.lastname: Nimphius
authors.forename: K
authors.initials: K
authors.lastname: Sturm
authors.forename: C
authors.initials: C
authors.lastname: Kill
authors.forename: T
authors.initials: T
authors.lastname: Wiesmann
authors.forename: H
authors.initials: H
authors.lastname: Wulf
authors.forename: H-H
authors.initials: HH
authors.lastname: Müller
mesh_terms: D000818:Animals; D001365:Axilla; D001917:Brachial Plexus / Q000502:physiology / Q000648:ultrastructure; D002404:Catheterization; D004558:Electric Stimulation / Q000379:methods*; D004567:Electrodes, Implanted; D055590:Electromagnetic Phenomena; D005121:Extremities / Q000294:innervation; D005260:Female; D005267:Femoral Nerve / Q000502:physiology / Q000648:ultrastructure; D006119:Groin; D009119:Muscle Contraction; D009407:Nerve Block / Q000379:methods*; D010525:Peripheral Nerves / Q000648:ultrastructure; D016037:Single-Blind Method; D034421:Sus scrofa; D013552:Swine