Radkowski Paweł, Grond Stefan, Brunner Horst, Wolska Joanna, Dawidowska-Fidrych Justyna, Ruść Jakub, Podhorodecka Katarzyna
Department of Anesthesiology and Intensive Care, University of Warmia and Mazury, Olsztyn, Poland.
Department of Anesthesiology and Intensive Care, Heiligen Geist Hospital, Fritzlar, Germany.
Anesth Pain Med. 2023 Jan 29;13(1):e132866. doi: 10.5812/aapm-132866. eCollection 2023 Feb.
Electromyography can be used for quantitative neuromuscular monitoring during general anesthesia, mostly using the stimulation train-of-four (TOF) pattern. Relaxometry measures the muscular response of the adductor pollicis muscle to electrical stimulation of the ulnar nerve, which is routinely used in clinical practices for monitoring the neuromuscular block. However, when it is not always possible to be used for all patients, the posterior tibial nerve is a suitable alternative.
Using electromyography, we compared the neuromuscular block between the ulnar and the posterior tibial nerves.
In this study, the participants were 110 patients who met inclusion criteria and submitted their written consent. Following the administration of cisatracurium intravenously, the patients had relaxometry performed simultaneously on the ulnar and the posterior tibial nerves using electromyography.
Eighty-seven patients were included in the final analysis. The onset time was 296 ± 99 s at the ulnar nerve and 346 ± 146 s at the tibial nerve, with a mean difference of -50 s and a standard deviation of 164 s. The 95% limits of agreement ranged from -372 s to 272 s. The relaxation time was 105 ± 26 min at the ulnar nerve and 87 ± 25 min at the tibial nerve, with a mean difference of 18 min and a standard deviation of 20 min.
Using electromyography, no statistically significant difference was noticed between the ulnar and the posterior tibial nerve during the neuromuscular block. The onset time and the relaxation time assessed with an electromyogram to compare the stimulation of the ulnar and posterior tibial nerves showed large limits of agreement.
肌电图可用于全身麻醉期间的定量神经肌肉监测，主要采用四个成串刺激（TOF）模式。松弛度测定法测量拇内收肌对尺神经电刺激的肌肉反应，这在临床实践中常用于监测神经肌肉阻滞。然而，当并非所有患者都能使用时，胫后神经是一种合适的替代选择。
我们使用肌电图比较了尺神经和胫后神经之间的神经肌肉阻滞情况。
在本研究中，参与者为110名符合纳入标准并签署书面同意书的患者。静脉注射顺式阿曲库铵后，使用肌电图对患者的尺神经和胫后神经同时进行松弛度测定。
最终分析纳入了87名患者。尺神经的起效时间为296±99秒，胫神经为346±146秒，平均差值为-50秒，标准差为164秒。95%的一致性界限范围为-372秒至272秒。尺神经的恢复时间为105±26分钟，胫神经为87±25分钟，平均差值为18分钟，标准差为20分钟。
使用肌电图时，在神经肌肉阻滞期间尺神经和胫后神经之间未发现统计学上的显著差异。通过肌电图评估的起效时间和恢复时间来比较尺神经和胫后神经的刺激情况，显示出较大的一致性界限。
