Davidson J E, Verderber A, Lake V, Weinger M, Partridge B, Munden B, Taylor J
University of California Medical Center, San Diego 92103-8929.
Am J Crit Care. 1994 Jul;3(4):273-5.
Peripheral nerve stimulation is necessary to quantify the level of neuromuscular blockade and prevent prolonged paralysis related to drug accumulation. Some nurses and physicians are hesitant to administer nerve stimulation because of concerns about inflicting pain on the patient.
To describe the feeling associated with train-of-four ulnar nerve stimulation, and to quantify discomfort, monitor heart rate response, and define the amount of current necessary to stimulate thumb adduction.
Healthy, nonmedicated volunteer subjects (N = 39) were asked to describe train-of-four ulnar nerve monitoring at 3 current strengths. Heart rate was monitored throughout the testing procedure. The milliamperes delivered at each current strength and the occurrence of thumb adduction were recorded.
Subjects described nerve stimulation generally as an unusual prickly sensation. On a discomfort scale of 1 to 10, the mean discomfort score when stimulated with the current setting at 4 (15.5-23.6 mA) was 3.63. Level 4 stimulation produced thumb adduction in 54% of subjects. No heart rate change occurred in response to nerve stimulation.
Nerve stimulation by train-of-four method was moderately uncomfortable but not painful. Heart rate response could not be relied on as a measurement of discomfort. Protocols for stimulation should include testing at level 4 and increasing as necessary to cause thumb adduction.
外周神经刺激对于量化神经肌肉阻滞水平以及预防与药物蓄积相关的长时间麻痹是必要的。一些护士和医生由于担心给患者带来疼痛而对进行神经刺激犹豫不决。
描述四个成串刺激尺神经时的感觉，量化不适程度，监测心率反应，并确定刺激拇指内收所需的电流量。
要求健康、未用药的志愿者受试者（N = 39）描述三种电流强度下的四个成串刺激尺神经监测情况。在整个测试过程中监测心率。记录每种电流强度下的毫安数以及拇指内收的发生情况。
受试者普遍将神经刺激描述为一种异常的刺痛感。在1至10的不适量表上，当电流设置为4（15.5 - 23.6毫安）时刺激的平均不适评分为3.63。4级刺激在54%的受试者中引起了拇指内收。神经刺激后未出现心率变化。
四个成串刺激法进行神经刺激有中度不适但不疼痛。心率反应不能作为不适程度的衡量指标。刺激方案应包括4级测试，并根据需要增加电流以引起拇指内收。
