naa a22 4500 510743749 CHVBK 20180411083037.0 cr unu---uuuuu 180411e20131001xx s 000 0 eng 10.1007/s12630-013-0002-z doi (NATIONALLICENCE)springer-10.1007/s12630-013-0002-z Electrophysiological stimulation (Tsui test) is feasible for epidural catheter positioning in adults with chronic back pain: a cohort study [Elektronische Daten] [Niamh McAuliffe, Sharon Pickworth, Tania DiRenna, Aaron Hong] La stimulation électrophysiologique (test de Tsui) est faisable pour le positionnement d'un cathéter péridural chez l'adulte souffrant de maux de dos chroniques: une étude de cohorte Purpose: Determining epidural catheter placement and accurately depositing corticosteroids at the site of the pathology in adults with chronic back pain can be challenging. Fluoroscopy is considered the standard of care for guiding epidural catheter positioning and subsequent injection in patients receiving epidural corticosteroids, but the technique has some limitations. We hypothesized that electrophysiological stimulation using the Tsui test is feasible for determining the appropriate epidural catheter position in adults with chronic back pain receiving epidural corticosteroids. Methods: We conducted a prospective cohort study of 12 patients receiving epidural corticosteroid injections for chronic back pain. Anatomical landmarks and epidural needle positions were initially confirmed by fluoroscopy. Epidural catheter position was assessed according to sensory and motor responses, as described by Tsui et al. (Can J Anaesth 45: 640-644, 1998). The current was increased slowly from zero until muscle activity was visible or the current reached 10mA. The catheter was then advanced until muscle responses occurred in the desired myotome. The test was deemed positive or negative according to the Tsui criteria. The anatomical level was confirmed by fluoroscopy prior to injection. Results: Electrophysiological stimulation effectively established the appropriate epidural catheter position in 11 patients (92%). Epidural stimulation occurred at a mean (SD) threshold of 3.95 (3.35) mA. The kappa statistic between interventions was 0.65, indicating a substantial level of agreement. Conclusion: This study demonstrated that electrophysiological stimulation using the Tsui technique is feasible for epidural catheter positioning in adults with chronic back pain. It may optimize epidural steroid injection in this population. Canadian Anesthesiologists' Society, 2013 McAuliffe Niamh Department of Anesthesia and Pain Medicine, St. Michael's Hospital, 30 Bond St, M5B 1W8, Toronto, ON, Canada aut Pickworth Sharon Department of Anesthesia and Pain Medicine, St. Michael's Hospital, 30 Bond St, M5B 1W8, Toronto, ON, Canada aut DiRenna Tania Department of Anesthesia and Pain Medicine, St. Michael's Hospital, 30 Bond St, M5B 1W8, Toronto, ON, Canada aut Hong Aaron Department of Anesthesia and Pain Medicine, St. Michael's Hospital, 30 Bond St, M5B 1W8, Toronto, ON, Canada aut Canadian Journal of Anesthesia/Journal canadien d'anesthésie Springer US; http://www.springer-ny.com 60/10(2013-10-01), 976-981 0832-610X 60:10<976 2013 60 12630 https://doi.org/10.1007/s12630-013-0002-z text/html Onlinezugriff via DOI 1 research-article jats NATIONALLICENCE 856 40 https://doi.org/10.1007/s12630-013-0002-z text/html Onlinezugriff via DOI NATIONALLICENCE 700 1- McAuliffe Niamh Department of Anesthesia and Pain Medicine, St. Michael's Hospital, 30 Bond St, M5B 1W8, Toronto, ON, Canada aut NATIONALLICENCE 700 1- Pickworth Sharon Department of Anesthesia and Pain Medicine, St. Michael's Hospital, 30 Bond St, M5B 1W8, Toronto, ON, Canada aut NATIONALLICENCE 700 1- DiRenna Tania Department of Anesthesia and Pain Medicine, St. Michael's Hospital, 30 Bond St, M5B 1W8, Toronto, ON, Canada aut NATIONALLICENCE 700 1- Hong Aaron Department of Anesthesia and Pain Medicine, St. Michael's Hospital, 30 Bond St, M5B 1W8, Toronto, ON, Canada aut NATIONALLICENCE 773 0- Canadian Journal of Anesthesia/Journal canadien d'anesthésie Springer US; http://www.springer-ny.com 60/10(2013-10-01), 976-981 0832-610X 60:10<976 2013 60 12630 Metadata rights reserved Springer special CC-BY-NC licence nationallicence BK010053 XK010053 XK010000 NATIONALLICENCE NATIONALLICENCE NL-springer