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PubMedDate not supplied

What is the relationship between paresthesia and nerve stimulation for axillary brachial plexus block?

BACKGROUND AND OBJECTIVES: To quantify the motor threshold current of a needle following elicitation of paresthesia during axillary brachial plexus block (ABPB). METHODS: This is a prospective, observational study of ABPB in 72 patients. Having elicited paresthesia, the minimum current required to produce a motor response was noted. The development and success of the block were subsequently followed. RESULTS: Nineteen blocks were excluded (18 because of arterial puncture and 1 blocked needle). Of the remaining 53 blocks, 41 (77%) produced a motor response at 0.5 mA or less. The median current was 0.17 mA (range, 0.03 to 3.3 mA). The site of initial paresthesia and subsequent motor response were related in 43 (81%) of cases. CONCLUSIONS: A needle position causing paresthesia produced a motor response at 0.5 mA or less in 77% of cases studied. This current may, therefore, be a reasonable threshold to aim for when performing an ABPB.

Anesthetics, Local↗
PubMed2000

Multiple-injection axillary brachial plexus block: A comparison of two methods of nerve localization-nerve stimulation versus paresthesia.

UNLABELLED: We conducted this prospective study to compare the onset time and the success rate of a multiple-injection axillary brachial plexus block performed by using two methods of nerve localization: paresthesia elicitation or nerve stimulation. Each of the major nerves of the plexus was located by elicitation of a paresthesia (Group PAR; n = 50) or by nerve stimulation (Group PNS; n = 50) and injected with 10 mL of local anesthetic solution. Time to perform the block, onset time of the primary block, time to achieve readiness for surgery, and total anesthetic time were significantly shorter in Group PNS than in Group PAR. The incidence of complete block was larger in Group PNS than in Group PAR (91% vs 76%; P: < 0. 05), and this was related to a larger success rate for anesthetizing the radial and the musculocutaneous nerves (P: < 0.05). The frequency of venous puncture was larger in Group PAR (P: < 0.05). For multiple-injection axillary brachial plexus block, we conclude that nerve stimulation resulted in a greater success rate and a faster onset than paresthesia elicitation, and it should be considered when the radial and musculocutaneous nerve distributions are involved in the surgical area. IMPLICATIONS: Two methods of nerve localization were compared when performing an axillary brachial plexus block by the multiple-injection technique. Nerve stimulation provided a faster onset and a greater incidence of complete block, related to a better success rate for anesthetizing the radial and the musculocutaneous nerves, than paresthesia elicitation.

Analgesia↗
PubMed1991

Leg paresthesias induced by magnetic brain stimulation in patients with thoracic spinal cord injury.

We studied the induction of leg paresthesias by magnetic stimulation of the brain in seven patients with thoracic T9-12 spinal cord injury and in four normal volunteers by delivering transcranial magnetic stimulation over scalp positions 1 cm apart with a Cadwell MES-10 magnetic stimulator and an 8-shaped magnetic coil at 100% stimulus intensity. We asked subjects to report sensations felt after each stimulus. In all normal subjects, magnetic stimulation evoked sensations described as tingling or a wave descending along the leg, usually accompanied by EMG responses in leg muscles. In three of the seven patients, stimulation evoked sensations of tingling, numbness, touch, or a wave descending along the leg, lasting up to 10 seconds and referred to different parts of the legs and toes. In the patients, sensations were felt more distally the closer the site of stimulation was to the midline. Patients with leg paresthesias had less motor reorganization in abdominal muscles than those without paresthesias. These findings suggest that portions of the cortical representation areas for body parts deafferented by a complete spinal cord injury can remain related to those body parts for up to several years. A central origin of these paresthesias is probable.

Brain↗
PubMed2005

Can direct spinal cord injury occur without paresthesia? A report of delayed spinal cord injury after epidural placement in an awake patient.

UNLABELLED: We discuss the etiology of a delayed spinal cord injury after epidural anesthesia without paresthesia. The description of such a case in an awake, adult patient who underwent a Whipple resection is provided. An epidural was performed at approximately the T8-9 interspace with the patient in the sitting position after 1 mg of midazolam was administered. On the first attempt, a dural puncture occurred. The patient did not report any paresthesia or pain. The needle was withdrawn and a second attempt was made one interspace lower. At this level, the epidural catheter was advanced into the epidural space uneventfully. Postoperatively, the patient suffered decreased motor function in the right leg. Magnetic resonance imaging revealed high signal intensity within the spinal cord, indicating cord edema compatible with direct needle trauma. An extradural fluid collection consistent with a hematoma was also noted. Although it may be impossible to confirm if the spinal cord injury was a result of direct needle trauma, hematoma, or a combination of needle trauma and hematoma, these events clearly raise the important question of whether an awake patient will always report paresthesia secondary to spinal cord trauma. IMPLICATIONS: This case reminds anesthesiologists that we should not simply assume paresthesia will always occur and be reported if a needle encroaches on the spinal cord even in an awake patient.

Aged↗
PubMed2002

Idiopathic paresthesia reaction associated with rofecoxib.

OBJECTIVE: To report a case of a paresthesia-type reaction due to the use of rofecoxib in standard doses for the treatment of osteoarthritis. CASE SUMMARY: A 55-year-old white woman was receiving rofecoxib for treatment of osteoarthritis. The patient began to have tongue numbness and hand tingling and numbness shortly after starting therapy with rofecoxib. The occurrence and resolution of her symptoms correlated with the start and end of the therapy. DISCUSSION: An adverse reaction with rofecoxib is a likely explanation for the patient's symptoms. Paresthesias have been reported in 0.1-1.9% of patients who took rofecoxib during premarketing studies, but no causality has been established. One case report of paresthesias occurring in a 59-year-old white man who took one 20-mg dose of piroxicam is available. Information on when the reaction occurred in relation to the dose and resolution of the reaction was not recorded in this study. Our patient's reaction is best classified as idiopathic. CONCLUSIONS: We report the first case of a paresthesia-type reaction to rofecoxib in a patient receiving the drug in standard doses for treatment of osteoarthritis. Although the reaction is rare, clinicians should be aware of its potential.

Anti-Inflammatory Agents, Non-Steroidal↗
PubMed1992

Distal paresthesia in patients with cervical cord lesions.

Nine patients complaining of distal paresthesia were found to have spinal cord lesions with no evidence of peripheral nerve disease. This pattern may be due to central nervous system dysfunction, with a lesion being intramedullary or extramedullary. The sensory deficits were initially asymmetric. Paresthesias could originate from the hands and progress to the stocking-glove pattern. It was usually more severe in hands than in feet. The abnormal somatosensory evoked potentials, found in all patients, indicated a lesion involving the posterior column, a site supposed to be the pathologic basis of paresthesia. As hands and feet have relatively large somatotopic representation in the posterior column of the cervical cord, the paresthesia tends to localize over distal portions of extremities.

Adult↗
PubMed2005

Iatrogenic paresthesia in the third division of the trigeminal nerve: 12 years of clinical experience.

BACKGROUND: Iatrogenic paresthesia in the third division of the trigeminal nerve remains a complex clinical problem with major medicolegal implications. However, most lawsuits can be prevented through better planning of procedures and by obtaining informed consent. The purpose of this article is to present the authors" clinical experience over the past 12 years, to review the principles of prevention and management of trigeminal paresthesia and to highlight the resulting medicolegal implications. METHODS: The files of all 165 patients referred to the oral and maxillofacial surgery department for evaluation of iatrogenic paresthesia in the third division of the trigeminal nerve were reviewed. The characteristics of the subgroup of patients who had taken an attending dentist to court were compared with those of the other patients. RESULTS: Surgical extraction of impacted molars was the main cause of paresthesia in 109 (66%) of the 165 subjects. The alveolar nerve was affected in 89 (54%) subjects, the lingual nerve in 67 (41%) subjects, and both nerves were affected in 9 (5%) subjects. There were more female than male patients (ratio 2.2:1). Lawsuits were initiated in 33 (20%) of the cases; patients who initiated lawsuits were younger, were more likely to have experienced anesthesia and were more likely to need microsurgery (all p < 0.001). Poor surgical planning and lack of informed consent were the most common errors on the part of the dentists. CONCLUSIONS: An accurate evaluation of surgical indications and risk, good surgical technique, preoperative informed consent and sufficient postoperative follow-up should help to reduce the frequency of neurosensory deficits after dental treatment and attendant lawsuits.

Adult↗
PubMedDate not supplied

Direction of catheter insertion and incidence of paresthesias and failure rate in continuous epidural anesthesia: a comparison of cephalad and caudad catheter insertion.

BACKGROUND AND OBJECTIVES: Paresthesias and unblocked segments during continuous epidural anesthesia--sometimes leading to higher doses of local anesthetics--can increase the risk of this technique. A cephalad insertion of the epidural catheter might decrease the incidence of these problems, but this has not been evaluated before in a controlled study. METHODS: In a prospective, double-blind, randomized study, we compared the incidence of paresthesias during catheter insertion and the failure rate of continuous epidural anesthesia in two groups of obstetric patients. In group 1 (n = 52), the Tuohy needle bevel was directed cephalad during catheter insertion. In group 2 (n = 53), it was directed caudad. The catheter was introduced 4-5 cm into the epidural space, and bupivacaine 25 mg plus fentanyl 50 micrograms were administered through it. RESULTS: Twenty percent of the patients in group 1 had paresthesias versus 40% in group 2 (p = 0.0249; 95% confidence interval of the difference 1-40%); intensity of paresthesias was greater in group 2. Pain relief was complete in 75% and 80% of the patients in groups 1 and 2, respectively (NS); three patients in group 1 and one in group 2 had unblocked segments (NS). CONCLUSIONS: Our results support the contention that the catheter should be directed cephalad during insertion for continuous epidural anesthesia.

Adult↗
PubMed1994

[Paresthesia: incidence following the extraction of 455 mandibular impacted third molars].

The incidence of paresthesia following the extraction of 455 mandibular impacted wisdom teeth is evaluated. No permanent paresthesia to the third branch of the trigeminal nerve is noted and no lingual paresthesia. A temporary dyesthesia of the inferior dental nerve is noted for three patients, with a complete return of integrity after six weeks. We have noted an incidence of temporary paresthesia of 3/455 (0.66 per cent) per tooth.

Adolescent↗
PubMed1997

Paresthesias: a practical diagnostic approach.

Paresthesias may be caused by central or peripheral nervous system abnormalities. Central nervous system-induced paresthesias are most commonly caused by ischemia, structural or compressive phenomena, infection, inflammation or degenerative conditions. Peripherally induced paresthesias can be caused by entrapment syndromes, metabolic disturbances, trauma, inflammation, connective tissue diseases, toxins, hereditary conditions, malignancies, nutritional deficiencies and miscellaneous conditions. Confirming the diagnosis and establishing an etiology may require appropriate laboratory and radiologic studies, or other studies. In most cases, the specific clinical syndromes associated with the paresthesias, coupled with the presenting neurologic findings, provide the physician with a framework for the diagnosis.

Central Nervous System Diseases↗
PubMed2003

Inferior alveolar nerve paresthesia relieved by microscopic endodontic treatment.

We experienced two cases of inferior alveolar nerve paresthesia caused by root canal medicaments, which were successfully relieved by microscopic endodontic treatment. In the first case, the paresthesia might have been attributable to infiltration of calcium hydroxide into the mandibular canal through the root canals of the mandibular left second molar tooth. In the second case, the paresthesia might have been attributable to infiltration of paraformaldehyde through the root canals of the mandibular right second molar tooth. The paresthesia was relieved in both cases by repetitive microscopic endodontic irrigation using physiological saline solution in combination with oral vitamin B12 and adenosine triphosphate.

Adult↗
PubMed1998

Caffeine inhibits paresthesia induced by herpes simplex virus through action on primary sensory neurons in rats.

Herpetic infection causes paresthesia, including hypoalgesia, in humans and hypoalgesia in rats. This study was conducted to examine the effect of caffeine, which inhibits replication of herpes simplex virus type-1 (HSV) and affects several neuronal functions, on HSV-induced paresthesia in rats. HSV-induced hypoalgesia was suppressed by repeated treatment of unilateral hindpaw with 10% caffeine gel regardless of when the treatment was started. Repeated treatment with acyclovir, an anti-HSV agent, suppressed HSV-induced hypoalgesia only when started before inoculation; acyclovir did not produce therapeutic effects on the HSV-induced sensory abnormality. Many dorsal root ganglion neurons were positive for HSV antigen following HSV inoculation of the hindpaw. Repeated treatment with caffeine and acyclovir markedly decreased HSV antigen-positive neurons in the dorsal root ganglia when started before, but not 2 or 4 days after, infection. These results suggest that topical caffeine inhibited HSV-induced paresthesia through direct action on sensory neurons, and that not only antiviral activity but also direct alteration of neural functions are involved in the caffeine sensory actions.

Acyclovir↗
PubMed1997

Lingual nerve paresthesia following third molar surgery: a retrospective clinical study.

Lingual nerve anesthesia, paresthesia, and dysesthesia are possible side effects of third molar extraction. These unwanted complications are frequently disturbing to both the patient and practitioner. The incidence of lingual nerve damage following third molar surgery is more frequent than once thought. Six hundred questionnaires were sent to randomly selected Fellows of the American Association of Oral and Maxillofacial Surgeons in 50 states to determine the parameters surrounding this phenomenon. Of the 452 respondents, 76.05% reported having had patients with lingual anesthesia, dysesthesia, or paresthesia. Of all the reported cases, 18.64% of the cases failed to resolve. Of the reported cases, only three underwent surgical intervention. Because many cases of lingual nerve dysfunction do not resolve, it is important to inform patients that microsurgical nerve repair techniques are available as a modality of treatment following diagnosis. It has also been recommended that if the paresthesia does not resolve within 10 to 12 weeks, then management options including microsurgical nerve reconstruction within a short period of time should be discussed as a plan with the patient.

Anesthesia, Dental↗
PubMed2004

Mental nerve paresthesia associated with an adhesive resin restoration: a case report.

A case is reported in which mental nerve paresthesia was associated with an adhesive resin restoration placed in direct contact with the pulp of a mandibular molar. The restoration was removed, and the paresthesia had completely resolved after nonsurgical endodontic therapy. Epicutaneous patch testing response indicated a possible causal relationship between the filling material and paresthesia.

Adult↗
PubMed1993

Analysis of parameters for epidural spinal cord stimulation. 3. Topographical distribution of paresthesiae--a preliminary analysis of 266 combinations with contacts implanted in the midcervical and midthoracic vertebral levels.

As a part of the systematic analysis of parameters involved in electrical epidural spinal cord stimulation therapy, distribution of paresthesiae in accordance with the position of contacts, as related to midline and vertebral level of contacts, was investigated. A preliminary analysis performed for 266 combinations having contacts implanted in the midcervical and low-thoracic vertebral levels showed that the topographical spread of the paresthesiae did not always cover the classical dermatomes. Significant paresthesiae spread was found as follows: C4-midline, unipolar combinations; the hand, forearm and upperarm, bipolar combinations; the hand, forearm; C4-lateral, unipolar combinations: the anterior shoulder, forearm, upper arm and hand, bipolar combinations: the hand, forearm and upper arm; T10-midline, unipolar combinations: the anterior and posterior of thigh, leg, knee, ankle and foot, bipolar combinations: the anterior and posterior thigh, leg, knee and foot; T10-lateral, unipolar combinations: the abdomen, anterior leg, knee and anterior thigh, bipolar combinations: the anterior thigh, anterior leg, knee and foot. This preliminary analysis suggests that more detailed studies would be worthwhile in the investigation of sensory responses to electrical stimulation of the spinal cord with epidural electrodes. Findings from such investigations could also be useful to extend our present anatomical knowledge of central and peripheral sensory neural structures.

Cervical Vertebrae↗
PubMed2006

Nerve localization techniques for interscalene brachial plexus blockade: a prospective, randomized comparison of mechanical paresthesia versus electrical stimulation.

Postoperative neurologic symptoms (PONS) are relatively common after upper extremity orthopedic surgery performed under peripheral neural blockade. In this study, we prospectively compared the incidence of PONS after shoulder surgery under interscalene (IS) block using the electrical stimulation (ES) or mechanical paresthesia (MP) techniques of nerve localization. For patients randomized to the MP group, a 1-in, 23-g long-beveled needle was placed into the IS groove to elicit a paresthesia to the shoulder, arm, elbow, wrist, or hand. For patients randomized to the ES group, a 5-cm, 22-g short-beveled insulated needle was placed into the IS groove to elicit a motor response including flexion or extension of the elbow, wrist, or fingers or deltoid muscle stimulation at a current between 0.2 and 0.5 mA. Each IS block was performed with 50-60 mL of 1.5% mepivacaine containing 1:300,000 epinephrine and 0.1meq/L sodium bicarbonate. Two-hundred-eighteen patients were randomized between the two groups. One patient was lost to follow-up. Twenty-five patients (23%) in the ES group experienced paresthesia during needle insertion. The incidence of PONS using the ES technique was 10.1% (11/109), whereas the incidence with the MP technique was 9.3% (10/108) (not significant). The PONS lasted a median duration of 2 mo, and symptoms in all patients resolved within 12 mo. The success rate, onset time, and patient satisfaction were also comparable between groups. We conclude that the choice of nerve localization technique can be made based on the patient's and anesthesiologist's comfort and preferences and not on concern for the development of PONS.

Adult↗
PubMed2003

Newtom QR-DVT 9000 imaging used to confirm a clinical diagnosis of iatrogenic mandibular nerve paresthesia.

This article describes conventional orthodontic treatment of an adult patient leading to lower lip paresthesia. The paresthesia subsided when the cross elastics to correct the patient's single molar crossbite were removed. It was determined with Digital Volumetric Tomography that the inferior alveolar nerve was located lingual to the lower second molar root and was impinged upon with the tipping force of the cross elastic. Treatment to resolve the crossbite without further paresthesia is discussed.

Activator Appliances↗
PubMed2004

Infection-related inferior alveolar and mental nerve paresthesia: case reports.

Nerve injury can be related to mechanical, chemical, and thermal factors. Infection-related paresthesia is usually related to mechanical pressure and ischemia associated with the inflammatory process. Another cause of paresthesia could be the toxic metabolic products of bacteria or inflammatory products released following tissue damage. This article presents cases of inferior alveolar and mental nerve paresthesia caused by an infected impacted tooth, an infected cyst, and periapical infection. The possible pathophysiologic mechanism of nerve injury, therapy, and prognosis for recovery are also discussed.

Adult↗