nach oben

Canadian Journal of Anesthesia/Journal canadien d'anesthésie

Erschienen in:

01.10.2013 | Reports of Original Investigations

Electrophysiological stimulation (Tsui test) is feasible for epidural catheter positioning in adults with chronic back pain: a cohort study

verfasst von: Niamh A. McAuliffe, MBBCh, Sharon Pickworth, MBBS, Tania DiRenna, MD, Aaron Hong, MD

Erschienen in: Canadian Journal of Anesthesia/Journal canadien d'anesthésie | Ausgabe 10/2013

Einloggen, um Zugang zu erhalten

Abstract

Purpose

Determining epidural catheter placement and accurately depositing corticosteroids at the site of the pathology in adults with chronic back pain can be challenging. Fluoroscopy is considered the standard of care for guiding epidural catheter positioning and subsequent injection in patients receiving epidural corticosteroids, but the technique has some limitations. We hypothesized that electrophysiological stimulation using the Tsui test is feasible for determining the appropriate epidural catheter position in adults with chronic back pain receiving epidural corticosteroids.

Methods

We conducted a prospective cohort study of 12 patients receiving epidural corticosteroid injections for chronic back pain. Anatomical landmarks and epidural needle positions were initially confirmed by fluoroscopy. Epidural catheter position was assessed according to sensory and motor responses, as described by Tsui et al. (Can J Anaesth 45: 640-644, 1998). The current was increased slowly from zero until muscle activity was visible or the current reached 10 mA. The catheter was then advanced until muscle responses occurred in the desired myotome. The test was deemed positive or negative according to the Tsui criteria. The anatomical level was confirmed by fluoroscopy prior to injection.

Results

Electrophysiological stimulation effectively established the appropriate epidural catheter position in 11 patients (92%). Epidural stimulation occurred at a mean (SD) threshold of 3.95 (3.35) mA. The kappa statistic between interventions was 0.65, indicating a substantial level of agreement.

Conclusion

This study demonstrated that electrophysiological stimulation using the Tsui technique is feasible for epidural catheter positioning in adults with chronic back pain. It may optimize epidural steroid injection in this population.

Abdi S, Datta S, Lucas LF. Role of epidural steroids in the management of chronic spinal pain: a systematic review of effectiveness and complications. Pain Physician 2005; 8: 127-43.PubMed

Boswell MV, Trescot AM, Datta S, et al. Interventional techniques: evidence-based practice guidelines in the management of chronic spinal pain. Pain Physician 2007; 10: 7-111.PubMed

Manchikanti L, Singh V, Cash KA, Pampati V, Damron KS, Boswell MV. A randomized, controlled, double-blind trial of fluoroscopic caudal epidural injections in the treatment of lumbar disc herniation and radiculitis. Spine (Phila Pa 1976) 2011; 36: 1897-905.CrossRef

Abdi S, Datta S, Trescot AM, et al. Epidural steroids in the management of chronic spinal pain: a systematic review. Pain Physician 2007; 10: 185-212.PubMed

el-Khoury GY, Ehara S, Weinstein JN, Montgomery WJ, Kathol MH. Epidural steroid injection: a procedure ideally performed with fluoroscopic control. Radiology 1988; 168: 7-554.

Hildebrandt J. Relevance of nerve blocks in treating and diagnosing low back pain—is the quality decisive? (German). Schmerz 2001; 15: 474-83.PubMedCrossRef

Manchikanti L, Bakhit CE, Pakanati RR, Fellows B. Fluoroscopy is medically necessary for the performance of epidural steroids. Anesth Analg 1999; 89: 1330-1.PubMed

Fredman B, Nun MB, Zohar E, et al. Epidural steroids for treating “failed back surgery syndrome”: is fluoroscopy really necessary? Anesth Analg 1999; 88: 367-72.PubMed

Manchikanti L, Cash KA, Pampati V, McManus CD, Damron KS. Evaluation of fluoroscopically guided caudal epidural injections. Pain Physician 2004; 7: 81-92.PubMed

10.

Tsui BC, Gupta S, Finucane B. Confirmation of epidural catheter placement using nerve stimulation. Can J Anaesth 1998; 45: 640-4.PubMedCrossRef

11.

Tsui BC, Wagner A, Cave D, Seal R. Threshold current for an insulated epidural needle in pediatric patients. Anesth Analg 2004; 99: 694-6.PubMedCrossRef

12.

Tsui BC, Bury J, Bouliane M, Ganapathy S. Cervical epidural analgesia via a thoracic approach using nerve-stimulation guidance in adult patients undergoing total shoulder replacement surgery. Acta Anaesthesiol Scand 2007; 51: 255-60.PubMedCrossRef

13.

Prusinkiewicz C, Lang S, Tsui BC. Lateral cervical epidural catheter placement using nerve stimulation for continuous unilateral upper extremity analgesia following a failed continuous peripheral nerve block. Acta Anaesthesiol Scand 2005; 49: 579-82.PubMedCrossRef

14.

American Society of Anesthesiologists Task Force on Chronic Pain Management; American Society of Regional Anesthesia and Pain Medicine. Practice guidelines for chronic pain management: an updated report by the American Society of Anesthesiologists Task Force on Chronic Pain Management and the American Society of Regional Anesthesia and Pain Medicine. Anesthesiology 2010; 112: 810-33.

15.

Tsui BC, Sze CK. An in vitro comparison of the electrical conducting properties of multiport versus single-port epidural catheters for the epidural stimulation test. Anesth Analg 2005; 101: 1528-30.PubMedCrossRef

16.

Charghi R, Chan SY, Kardash KJ, Finlayson RJ, de Tran QH. Electrical stimulation of the epidural space using a catheter with a removable stylet. Reg Anesth Pain Med 2007; 32: 152-6.PubMed

17.

Tsui BC. Predicting caudal epidural analgesia using nerve stimulation. Anaesthesia 2001; 56: 816-7.PubMedCrossRef

18.

Tsui BC, Guenther C, Emery D, Finucane B. Determining epidural catheter location using nerve stimulation with radiological confirmation. Reg Anesth Pain Med 2000; 25: 306-9.PubMed

19.

Airaksinen O, Brox JI, Cedraschi C, et al. Chapter 4. European guidelines for the management of chronic nonspecific low back pain. Eur Spine J 2006; 15(Suppl 2): S192-300.PubMedCrossRef

20.

Hoftman NN, Ferrante FM. Diagnosis of unintentional subdural anesthesia/analgesia: analyzing radiographically proven cases to define the clinical entity and to develop a diagnostic algorithm. Reg Anesth Pain Med 2009; 34: 12-6.PubMedCrossRef

21.

Stitz MY, Sommer HM. Accuracy of blind versus fluoroscopically guided caudal epidural injection. Spine (Phila Pa 1976) 1999; 24: 1371-6.CrossRef

22.

Abram SE, O’Connor TC. Complications associated with epidural steroid injections. Reg Anesth 1996; 21: 149-62.PubMed

23.

Heavner JE, Bosscher H. Epiduroscopy and radiation exposure. Reg Anesth Pain Med 2009; 34: 79.PubMedCrossRef

24.

Zhou Y, Singh N, Abdi S, Wu J, Crawford J, Furgang FA. Fluoroscopy radiation safety for spine interventional pain procedures in university teaching hospitals. Pain Physician 2005; 8: 49-53.PubMed

25.

Manchikanti L, Pampati V, Boswell MV, Smith HS, Hirsch JA. Analysis of the growth of epidural injections and costs in the Medicare population: a comparative evaluation of 1997, 2002, and 2006 data. Pain Physician 2010; 13: 199-212.PubMed

26.

Hogan QH, Mark L. Subdural injection: what’s the gold standard? Reg Anesth Pain Med 2009; 34: 10-1.PubMedCrossRef

27.

Hogan Q. Epidural catheter tip position and distribution of injectate evaluated by computed tomography. Anesthesiology 1999; 90: 964-70.PubMedCrossRef

28.

Tamai H, Sawamura S, Kanamori Y, Takeda K, Chinzei M, Hanaoka K. Thoracic epidural catheter insertion using the caudal approach assisted with an electrical nerve stimulator in young children. Reg Anesth Pain Med 2004; 29: 92-5.PubMed

29.

Ozawa T, Kaneko H, Nomura T, Asano M. Usefulness of epidural nerve stimulation to confirm epidural catheter placement (Japanese). Masui 2002; 51: 400-4.PubMed

30.

Tsui BC, Seal R, Koller J, Entwistle L, Haugen R, Kearney R. Thoracic epidural analgesia via the caudal approach in pediatric patients undergoing fundoplication using nerve stimulation guidance. Anesth Analg 2001; 93: 1152-5.PubMedCrossRef

31.

Dashfield AK, Taylor MB, Cleaver JS, Farrow D. Comparison of caudal steroid epidural with targeted steroid placement during spinal endoscopy for chronic sciatica: a prospective, randomized, double-blind trial. Br J Anaesth 2005; 94: 514-9.PubMedCrossRef

32.

Anderson SR, Racz GB, Heavner J. Evolution of epidural lysis of adhesions. Pain Physician 2000; 3: 262-70.PubMed

Titel: Electrophysiological stimulation (Tsui test) is feasible for epidural catheter positioning in adults with chronic back pain: a cohort study
verfasst von: Niamh A. McAuliffe, MBBCh
Sharon Pickworth, MBBS
Tania DiRenna, MD
Aaron Hong, MD
Publikationsdatum: 01.10.2013
Verlag: Springer US
Erschienen in: Canadian Journal of Anesthesia/Journal canadien d'anesthésie / Ausgabe 10/2013
Print ISSN: 0832-610X
Elektronische ISSN: 1496-8975
DOI: https://doi.org/10.1007/s12630-013-0002-z

Update AINS

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

hier abonnieren

Springer Medizin

Electrophysiological stimulation (Tsui test) is feasible for epidural catheter positioning in adults with chronic back pain: a cohort study