Efficacy and Safety of Nerve-stimulator-guide Needle Placement in Peripheral Nerve Block: A Systematic Review_Chinese Journal of Evidence-Based Medicine

Authors：

LIU Xinzhu , ZHOU Leng , ZHANG Yanju ,  LIU Bin

Department of Anesthesiology, West China Hospital of Sichuan University, Chengdu 610041, China;

Corresponding author：

LIU Bin, Email: benbinliu@hotmail.com

Keywords：

Nerve stimulator; Peripheral nerve block; Systematic review

DOI：

10.7507/1672-2531.20090100

Video：

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Objective 　To assess the efficacy and safety of nerve-stimulator-guide needle placement in the peripheral nerve blockade.
Methods 　The Cochrane Library, MEDLINE, OVID, VIP, CNKI and CBM were searched. The quality of the included studies was evaluated by three reviewers, and meta-analysis was performed.
Results 　Twenty studies involving 1 287 participants related to needle placement in the peripheral nerve blockade were included. There were only 2 studies that described a detailed randomization method and allocation concealment and blinding, and the others were inadequate. Meta-analysis based on the included studies showed that: ① Absolute success ratio: nerve-stimulator-guide was higher than eliciting paraesthesia (OR= 4.05, 95%CI 2.57 to 6.36, P lt;0.00001) and anatomy localization (OR=30.3, 95%CI 1.73 to 532.74, P=0.02), but lower than ultrasound-guide-localization (OR=0.27, 95%CI 0.10 to 0.74, P=0.01). ② Onset time of the block: nerve-stimulator-guide was similar to eliciting paraesthesia (WMD= –1.70, 95%CI –?4.50 to 0.95, P=0.08), faster than arteriopalmus localization (WMD= 8.38, 95%CI 0.72 to 16.04, P lt;0.000 01), but slower than ultrasound-guide-localization (WMD= 8.38, 95%CI 0.72 to 16.04, P=0.04). ③ Ratio of complication associated to block: nerve-stimulator-guide was similar to eliciting paraesthesia (OR= 1.01, 95%CI 0.55 to 1.86, P=0.97), anatomy localization (WMD= 0.06, 95%CI 0.00 to 1.21, P=0.07) and arteriopalmus localization (WMD= 8.82, 95%CI 0.10 to 4.11, P=0.65), but higher than ultrasound-guide-localization (OR= 5.03, 95%CI 1.74 to 14.49, P=0.003). ④ Time to block: nerve-stimulator-guide was similar to eliciting paraesthesia (WMD=0.02, 95%CI –0.46 to 0.51, P=0.92), shorter than arteriopalmus localization (WMD= –4.00, 95%CI –5.58 to –2.42, P lt;0.000 01) and longer than ultrasound-guide-localization (WMD= 1.90, 95%CI 0.47 to 3.33, P=0.009). ⑤ Patient-accepted ratio: nerve-stimulator-guide was higher than eliciting paraesthesia (OR=2.32, 95%CI 1.02 to 5.30, P=0.05), and similar to arteriopalmus localization (OR=8.14, 95%CI 0.88 to 75.48, P=0.06).
Conclusion 　Nerve-stimulator-guide location is a precise, effective and safe localization method. Due to moderate risk of selection bias and detection bias of included studies, the evidence is not b. Our results suggest that well-designed double-blind randomized controlled and larger-scale trials on the use of nerve stimulator in the peripheral nerve block are needed.

Citation： LIU Xinzhu,ZHOU Leng,ZHANG Yanju,LIU Bin. Efficacy and Safety of Nerve-stimulator-guide Needle Placement in Peripheral Nerve Block: A Systematic Review. Chinese Journal of Evidence-Based Medicine, 2009, 09(5): 542-551. doi: 10.7507/1672-2531.20090100 Copy

1.	Denny NM, Harrop-Griffiths W. Location, location, location! Ultrasound imaging in regional anaesthesia. Br J Anaesth, 2005, 94(1): 1-3.
2.	蒋茹. 周围神经刺激器在神经阻滞中的应用. 《国外医学》麻醉学与复苏分册. 2000, 21(1): 47-49.
3.	Smith BL. Efficacy of a nerve stimulator in regional analgesia: experience in a resident training programme. Anaesthesia, 1976, 31(6): 778-782.
4.	Baranowski AP, Pither CE. A comparison of three methods of axillary brachial plexus anaesthesia. Anaesthesia, 1990, 45(5): 362-365.
5.	Rodriguez J, Barcena M, Alvarez J. Axillary Brachial Plexus Anesthesia: Electrical Versus Cold Saline Stimulation. Anesth Analg, 1996, 83(4): 752-754.
6.	Sia S, Bartoli M, Lepri A, et al. Ponsecchi P. Multiple-Injection Axillary Brachial Plexus Block: A Comparison of Two Methods of Nerve Localization–Nerve Stimulation Versus Paresthesia. Anesth Analg, 2000, 91(3): 647-651.
7.	洛珉, 吴洁. 神经刺激器定位在臂丛神经阻滞麻醉中的应用. 山西医科大学学报, 2003, 34(2): 156-158.
8.	卜林明, 宋端怡, 戴峥. 便携式神经刺激器用于肌间沟臂丛神经阻滞的对比观察. 云南医药, 2004, 25(6): 502-503.
9.	车薛华, 梁伟民, 陈佳瑶. 三点法腋路臂丛神经阻滞——神经刺激器法和异感法的比较. 复旦学报(医学版), 2005, 32(5): 529-535.
10.	胡钦擎, 吴丽娟. 神经刺激器辅助定位在臂丛神经阻滞中的应用. 青海医药杂志, 2004, 34 (5): 6-7.
11.	金勉, 徐旭仲, 王建光. 神经刺激器引导下的肌间沟臂丛神经阻滞. 温州医学院学报, 2005, 35(3): 229-231.
12.	何文政, 林成新, 刘敬臣. 神经刺激器用于锁骨上臂丛神经定位阻滞的临床观察. 广西医科大学学报, 2005, 22(3): 358-360.
13.	贺昌林, 王一心. 神经刺激器定位阻滞用于肩锁部位手术的临床观察. 现代中西医结合杂志, 2005, 14(18): 2407-2408.
14.	林芩, 王翔锋. 神经刺激器定位在肥胖患者臂丛神经阻滞的应用. 福建医科大学学报, 2007, 41(2): 162-165.
15.	Marhofer P, Schrogendorfer K, Koinig H, et al. Ultrasonographic Guidance Improves Sensory Block and Onset Time of Three-in-One Blocks. Anesth Analg, 1997, 85(4): 854-857.
16.	Marhofer P, Schrogendorfer K, Wallner T, et al. Ultrasonographic Guidance Reduces the Amount of Local Anesthetic for 3-in-1 Blocks. Reg Anesth Pain Med, 1998, 23(6): 584-588.
17.	Chan VW, Perlas A, McCartney CJ, et al. Ultrasound guidance improves success rate of axillary brachial plexus block. Can J Anaesth, 2007, 54(3): 165-170.
18.	崔旭蕾, 徐仲煌, 陈绍辉, 等. 超声引导技术在肌间沟臂丛神经两点阻滞中的应用. 基础医学与临床, 2008, 28(3): 269-271.
19.	胡贵萍, 吴登友. 腋路臂丛神经阻滞- 3点神经刺激器定位法和透动脉法的比较. 贵州医药, 2007, 31(5): 428-429.
20.	张伟, 姚长智, 孙晓雄. 神经刺激器两点法定位行腋入臂丛神经阻滞80例报告. 北京医学, 2005, 27(1): 60-61.
21.	Doty R Jr, Sukhani R, Kendall MC, et al. Evaluation of a Proximal Block Site and the Use of Nerve-Stimulator-Guided Needle Placement for Posterior Tibial Nerve Block. Anesth Analg, 2006, 103: 1300-1305.
22.	张丽雯, 陈金生, 谢长春, 等. 神经刺激器在颈丛神经阻滞的应用评价. 现代医院, 2005, 5(12): 52-53.
23.	周仁龙, Jian Hang, 杭燕南. 神经阻滞定位的临床进展. 《国外医学》麻醉学与复苏分册, 2005, 26(3): 153-157.
24.	Urmey WF, Stanton J. Inability to consistently elicit a motor response following sensory paresthesia during interscalene block administration. Anesthesiology, 2002, 96(3): 552-554.
25.	Kapral S, Krafft P, Eibenberger K, et al. Ultrusound-guided supraclavicular approach for regional anesthesia of the brachial plexus. Anesth Analg, 1994, 78: 507-513.
26.	Hickey R, Garland TA, Ramamurthy S. Subclavian perivascular block: influence of location of paresthesia. Anesth Analg, 1989, 68: 767-771.

1. Denny NM, Harrop-Griffiths W. Location, location, location! Ultrasound imaging in regional anaesthesia. Br J Anaesth, 2005, 94(1): 1-3.
2. 蒋茹. 周围神经刺激器在神经阻滞中的应用. 《国外医学》麻醉学与复苏分册. 2000, 21(1): 47-49.
3. Smith BL. Efficacy of a nerve stimulator in regional analgesia: experience in a resident training programme. Anaesthesia, 1976, 31(6): 778-782.
4. Baranowski AP, Pither CE. A comparison of three methods of axillary brachial plexus anaesthesia. Anaesthesia, 1990, 45(5): 362-365.
5. Rodriguez J, Barcena M, Alvarez J. Axillary Brachial Plexus Anesthesia: Electrical Versus Cold Saline Stimulation. Anesth Analg, 1996, 83(4): 752-754.
6. Sia S, Bartoli M, Lepri A, et al. Ponsecchi P. Multiple-Injection Axillary Brachial Plexus Block: A Comparison of Two Methods of Nerve Localization–Nerve Stimulation Versus Paresthesia. Anesth Analg, 2000, 91(3): 647-651.
7. 洛珉, 吴洁. 神经刺激器定位在臂丛神经阻滞麻醉中的应用. 山西医科大学学报, 2003, 34(2): 156-158.
8. 卜林明, 宋端怡, 戴峥. 便携式神经刺激器用于肌间沟臂丛神经阻滞的对比观察. 云南医药, 2004, 25(6): 502-503.
9. 车薛华, 梁伟民, 陈佳瑶. 三点法腋路臂丛神经阻滞——神经刺激器法和异感法的比较. 复旦学报(医学版), 2005, 32(5): 529-535.
10. 胡钦擎, 吴丽娟. 神经刺激器辅助定位在臂丛神经阻滞中的应用. 青海医药杂志, 2004, 34 (5): 6-7.
11. 金勉, 徐旭仲, 王建光. 神经刺激器引导下的肌间沟臂丛神经阻滞. 温州医学院学报, 2005, 35(3): 229-231.
12. 何文政, 林成新, 刘敬臣. 神经刺激器用于锁骨上臂丛神经定位阻滞的临床观察. 广西医科大学学报, 2005, 22(3): 358-360.
13. 贺昌林, 王一心. 神经刺激器定位阻滞用于肩锁部位手术的临床观察. 现代中西医结合杂志, 2005, 14(18): 2407-2408.
14. 林芩, 王翔锋. 神经刺激器定位在肥胖患者臂丛神经阻滞的应用. 福建医科大学学报, 2007, 41(2): 162-165.
15. Marhofer P, Schrogendorfer K, Koinig H, et al. Ultrasonographic Guidance Improves Sensory Block and Onset Time of Three-in-One Blocks. Anesth Analg, 1997, 85(4): 854-857.
16. Marhofer P, Schrogendorfer K, Wallner T, et al. Ultrasonographic Guidance Reduces the Amount of Local Anesthetic for 3-in-1 Blocks. Reg Anesth Pain Med, 1998, 23(6): 584-588.
17. Chan VW, Perlas A, McCartney CJ, et al. Ultrasound guidance improves success rate of axillary brachial plexus block. Can J Anaesth, 2007, 54(3): 165-170.
18. 崔旭蕾, 徐仲煌, 陈绍辉, 等. 超声引导技术在肌间沟臂丛神经两点阻滞中的应用. 基础医学与临床, 2008, 28(3): 269-271.
19. 胡贵萍, 吴登友. 腋路臂丛神经阻滞- 3点神经刺激器定位法和透动脉法的比较. 贵州医药, 2007, 31(5): 428-429.
20. 张伟, 姚长智, 孙晓雄. 神经刺激器两点法定位行腋入臂丛神经阻滞80例报告. 北京医学, 2005, 27(1): 60-61.
21. Doty R Jr, Sukhani R, Kendall MC, et al. Evaluation of a Proximal Block Site and the Use of Nerve-Stimulator-Guided Needle Placement for Posterior Tibial Nerve Block. Anesth Analg, 2006, 103: 1300-1305.
22. 张丽雯, 陈金生, 谢长春, 等. 神经刺激器在颈丛神经阻滞的应用评价. 现代医院, 2005, 5(12): 52-53.
23. 周仁龙, Jian Hang, 杭燕南. 神经阻滞定位的临床进展. 《国外医学》麻醉学与复苏分册, 2005, 26(3): 153-157.
24. Urmey WF, Stanton J. Inability to consistently elicit a motor response following sensory paresthesia during interscalene block administration. Anesthesiology, 2002, 96(3): 552-554.
25. Kapral S, Krafft P, Eibenberger K, et al. Ultrusound-guided supraclavicular approach for regional anesthesia of the brachial plexus. Anesth Analg, 1994, 78: 507-513.
26. Hickey R, Garland TA, Ramamurthy S. Subclavian perivascular block: influence of location of paresthesia. Anesth Analg, 1989, 68: 767-771.

Chinese Journal of Evidence-Based Medicine

Efficacy and Safety of Nerve-stimulator-guide Needle Placement in Peripheral Nerve Block: A Systematic Review

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