Intraoperative monitoring of ischiatic nerve function with sensory evoked potentials

The effect of loco-regional anaesthesia on motor activity induced by direct stimulation of the sciatic nerve in dogs

A prospective, randomised, blinded, case-controlled clinical study was designed using client-owned dogs undergoing unilateral pelvic limb orthopaedic surgery, to determine the effect on induced motor activity by electrical stimulation of the sciatic nerve distal to the site of local anaesthetic administration. Dogs were administered 0.5% bupivacaine either extradurally or via a femoral and transgluteal sciatic electrolocation-guided nerve block prior to pelvic limb surgery. Motor response to electrical stimulation of branches of the sciatic nerve was tested and the minimum current required to induce muscle twitch was recorded prior to bupivacaine administration. Provided sensory blockade had been deemed successful intraoperatively, testing was repeated postoperatively, with each dog acting as its own control. Paired t-tests were performed to compare pre- and postoperative minimum currents. Eleven dogs administered extradural and 11 dogs administered femoral and sciatic perineural bupivacaine were eligible for post-operative testing. All dogs displayed normal motor response to electrical stimulation of the sciatic nerve at both sites tested before and after bupivacaine administration. There was no significant difference in the minimum current required to induce muscle twitch between pre- and post-operative testing (P = 0.31 sciatic site, P = 0.36 peroneal site), nor between the two groups using different loco-regional anaesthetic techniques (minimum P = 0.13). This study shows that stimulation of the sciatic nerve distal to the site of bupivacaine administration induces motor activity, despite adequate sensory blockade. This is relevant in surgical cases where mechanical stimulation of the sciatic nerve might be expected and needs to be recognised to avoid postoperative neurapraxia.

Sufentanil and nitrous oxide anaesthesia for the recording of transcranial magnetic motor evoked potentials in dogs

Transcranial magnetic motor evoked potentials were recorded from the extensor carpi radialis muscle of the forelimbs and from the cranial tibial muscle of the hindlimbs of anaesthetised dogs. The dogs were premedicated with droperidol and fentanyl and a light plane of anaesthesia was induced and maintained with sufentanil and nitrous oxide. The potentials recorded under sufentanil and nitrous oxide anaesthesia were suppressed in comparison with baseline recordings under droperidol and fentanyl sedation: their latencies were significantly increased and their amplitudes significantly decreased (P < 0.05). However, the potentials could be recorded reliably in all the dogs and with very good reproducibility. This narcotic anaesthesia also allowed sensory evoked potentials to be recorded reliably.

Electrodiagnostic examination. Somatosensory evoked potentials and electromyography

The anatomic/physiologic basis and uses of somatosensory evoked potential recordings are presented. A brief summary of the use of electromyography in spinal cord diseases is included.