Role of local anesthetic spread pattern and electrical stimulation in ultrasound-guided musculocutaneous nerve block

Abstract 

Study Objective

To evaluate local anesthetic spread on the frequency of success of musculocutaneous nerve block, and to determine needle-to-target-nerve distance by ultrasound imaging and electrical stimulation.

Design

Observational study.

Settings

Private hospital.

Patients

48 ASA physical status I and II adults (16 men and 32 women) scheduled for elective carpal tunnel release or wrist ganglion cyst surgery in an outpatient setting.

Interventions

The musculocutaneous nerve (MCN) was identified by ultrasound. An insulated needle connected to an electrical stimulator in the “off” position was inserted in the biceps side of the probe in the plane of the ultrasound beam. The needle tip was placed in the vicinity of the MCN.

Measurements

Local anesthetic spread pattern was determined by ultrasound imaging. The lowest effective current intensity was registered. The average depth of the MCN was measured by ultrasound.

Main Results

In all patients, the local anesthetic solution spread was uneven. In 32% of patients (15/47), motor response was still elicited with electrical stimulation intensity lower or equal to 0.3 mA. In 26% of patients (12/47), motor response disappeared with electrical stimulation intensity higher or equal to 0.6 mA. In 42% of patients (20/47), motor response disappeared at intensities between 0.3 mA and 0.5 mA.

Conclusions

A high success rate of MCN anesthesia occurred with non-circumferential spread of local anesthetic solution. Electrical current intensity was not a reliable indicator of needle-to-target-nerve distance.

Keywords: Electrical nerve stimulation, Local anesthetic spread, Musculocutaneous nerve, Peripheral nerve blocks, Regional anesthesia, Ultrasound guidance