Do you still stimulate your catheters?

[bullard]

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A post over on Sermo got me thinking...

I am proficient with the ultrasound for the usual single-shot blocks: interscalene, supraclavicular, femoral, popliteal. I generally don't use nerve stimulation except for some fat legs when doing a popliteal or a subgluteal sciatic, just to confirm that I am indeed aiming for nerve and not fat. However, for catheters, I've been using both ultrasound and nerve stimulation because that's how I was trained as a resident -- something about stimulating catheters working better than non-stimulating catheters.

So is there any recent data to support that assertion? Or should I just get a good image, inject my local, and just thread the damn catheter and be done with it? It's what I'd much rather do...plus then I can just use an epidural kit for my materials.

 

[Lee123]

I stimulate ISB, popliteals, femorals, sciatic. I don't stimulate supraclaviculars. I only use US for supraclaviculars and popliteals (unless they are morbidly obese).

That's just how I do them.

 

[Oggg]

I think there is no evidence of superiority of one or another.

 

[dhb]

I think it's better to locate the catheter under US and see the spread when you inject.

 

[bullard]

I should clarify. By recent data, I mean anything. Like, "I put in 10 femoral nerve catheters a week in a busy practice and I never stimulate and the surgeons and patients love me." That's good enough for me.

 

[imfrankie]

My recollection is there is "evidence" that the secondary block is more reliable when stim caths are used.
I don't use them, however. Too much money for my taste.

 

[bostonblaz]

I dont ever stim caths. I do however only inject local in the cath not the needle so i know that it works before i send them home with it

 

[pgg]

I put caths in with ultrasound. If I'm using nerve stim as backup, I'll also stim the catheter for the hell of it, but I'll still take a catheter that won't stim if I was convinced by the ultrasound. I inject through the catheter only and visualize spread.


Before I was routinely using ultrasound, I would commonly get a great stim with the Tuohy, slip in the catheter, and get no stim from it, or only a twitch at several tenths higher. They still worked great 90%+ of the time, so in my mind absence of catheter stim != bad catheter.