Standardization of the Nerve Localization Technique in Percutaneous Peripheral Nerve Blockade

Sung, Duk Hyun; Kwon, Jeong Yi; Chang, Doo Yeul; Lee, Young Taek

Abstract

OBJECTIVE
We compared a few variables such as the type of needle, the direction of bevel, and the effect of stimulation duration in percutaneous peripheral nerve blockade. We also studied the real distribution of injected drug through nerve biopsy. METHOD: The sciatic nerve-tibialis posterior muscle preparation of rabbit was chosen as a model. Experimental rabbits were divided into 3 groups: Group 1 (16 legs), use of insulated needle and 100 microsecond stimulation duration; Group 2 (9 legs), use of insulated needle and 240 microsecond stimul ation duration; Group 3 (6 legs), use of uninsulated needle and 100 microsecond stimulation duration. The mixed solution, 0.1 cc, of 5% phenol and indian ink was injected in 10 legs and the muscles were obtained to observe the spreads of injected solution after 2 weeks.
RESULTS
The minimal stimulation currents of group 1, 2, 3 were 0.49 mA, 0.37 mA, 2.07 mA, respectively. The distance between needle and sciatic nerve sheath of group 1, 2, 3 were 0.09 mm, 0.11 mm, 0.20 mm in width, and 1.84 mm, 3.33 mm, 4.50 mm in depth, respectively. The current required to stimulate the nerve increased rapidly as the tip of the insulated needle passed the nerve, and the direction of bevel had no effect on the minimal stimulation current. Injected indian ink was located alongside the perineurium.
CONCLUSION
In three methods, the most exact method was the use of insulated needle and 100s stimulation duration. The needle tip was located 1.84 mm past the nerve.