Determining epidural catheter location using nerve stimulation with radiological confirmation

Background and Objectives: The use of epidural stimulation to confirm epidu ral catheter placement has been shown. This case report describes the benef its and problems of using the epidural stimulation test to confirm epidural catheter placement and provides supporting evidence for these observations using radiological imaging. Case Report: Methods: A nerve stimulator was connected to the proximal end of an epidural catheter ter via an adapter. The cathode lead was connected to the adapter. The anode lead was connected to an electrode placed on the upper extremity as a grounding site. Using 1 to 10 mA current, a segmental motor response indicated that the catheter was in the epidural space. The a bsence of a motor response indicated that it was not. Cases: In the first patient, the new test predicted subcutaneous epidural c atheter placement, which was subsequently confirmed radiologically. In the second patient, the catheter rip was found to be lying near a nerve root, w hich was again confirmed radiologically. In the third case, a negative lest was initially observed with only local muscle movement over the biceps are a (T-2) After relocation of the grounding electrode to the lower extremity, segmental intercostal muscle movement (T4-5 level) was observed. The cathe ter placement was radiologically shown to be in the T4-5 region. Conclusion: This report illustrates some of the potential benefits and prob lems of using the nerve stimulation rest to confirm epidural catheter place ment, with radiological verification.