Session Title: Virtual Poster Hall
Session Time: None. Available on demand.
Disclosures: Harla Kelly O’Donnell, DO: No financial relationships or conflicts of interest
Case Description: A 19 year old female with anoxic brain injury due to cardiac arrest, status post AICD implantation, presented with significant upper and lower spasticity. Her spasticity in the left pectoralis major and minor was severe, warranting diagnostic selective motor nerve blocks as a prelude to chemodenervation. However, the presence of the patient’s AICD and potential for misreading of electrical nerve stimulation and misfire was a concern.
Setting: The patient presented to the Center for Tone Management, a private practice, for management of her spasticity.
Patient: The patient was a 19 year old female who suffered a cardiac arrest, which resulted in anoxic brain injury. During her initial hospitalization, an AICD was placed. Her course was complicated by severe spasticity. Assessment/
Results: In order to assess the safety of performing diagnostic selective motor nerve blocks to nerves innervating the left pectoralis major and minor muscles, the manufacturer of the AICD was contacted to monitor the patient’s AICD. A representative presented to the office for the nerve block procedure. The AICD’s ability to fire was disabled, however, its ability to record was maintained. An external defibrillator was present. In performing selective motor nerve blocks, motor nerves innervating the aforementioned muscles were first identified using a transcutaneous nerve stimulator, followed by more precise localization with a transdermal needle electrode starting at a current at 0.35 milliamps. Current was reduced as the nerve was approached. Continuous EKG and AICD monitoring during electrical nerve stimulation revealed no recording of the electrical stimulation.
Discussion: For patients with pectoralis spasticity, with overlying AICD, device recording and interpretation of local electrical stimulation may be monitored for misinterpretation while performing motor nerve blocks.
Conclusion: An AICD in patients with severe pectoralis spasticity may present to be a relative contraindication to diagnostic selective motor nerve blocks, however, safety and can be ascertained with appropriate monitoring.
Level of Evidence: Level V
To cite this abstract in AMA style:O'Donnell HK, Paulin M. Selective Motor Nerve Blocks with Nerve Stimulation in a Patient with an AICD [abstract]. PM R. 2020; 12(S1)(suppl 1). https://pmrjabstracts.org/abstract/selective-motor-nerve-blocks-with-nerve-stimulation-in-a-patient-with-an-aicd/. Accessed September 22, 2023.
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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/selective-motor-nerve-blocks-with-nerve-stimulation-in-a-patient-with-an-aicd/