reply to sood et al
TRANSCRIPT
References
1. Aramideh M, van den Oever HLA, Walstra GJ, Dzoljic M.Spinal anesthesia as a complication of brachial plexusblock using the posterior approach. Anesth Analg (in press).
2. Passamante AN. Spinal anesthesia and permanent neurologicdeficit after interscalene block. Anesth Analg 1996;82:873-874.
3. Dagli G, Guzeldemir ME, Acar HV. The effect and side effectsof interscalene brachial plexus block by posterior ap-proach. Reg Anesth Pain Med 1998;23:87-91.
4. Borgeat A, Ekatodramis G, Kalberer F, Benz C. Acute andnonacute complications associated with interscaleneblock and shoulder surgery. Anesthesiology 2001;95:875-880.
Accepted for publication February 19, 2002.doi:10.1053/rapm.2002.33553
Vibration Sensation Testing Over the MedialMalleolus
To the Editor:We read the article by Schulz-Stubner et al. in the
November-December 2001 issue of Regional Anesthesiaand Pain Medicine and found it very interesting and infor-mative. Surely, it could be very useful in anesthesia prac-tice. However, while going through the article, we ob-served that site of vibration sense testing mentioned inthe Methods is lateral malleolus, whereas in the Discus-sion it is mentioned to be medial malleolus. We under-stand it may be a printing error.
In India and other South Asian countries people, whiledoing their routine work, are in the habit of squattingcross-legged on the floor so that hips and lateral malleo-lus remain in contact with the floor bearing the bodyweight. This leads to thickening of the skin and subcuta-neous tissue over the lateral malleolus and decreasedperception of the vibration sensation. Therefore, it is aconvention to test the vibration sensation over the medialmalleolus.
Dinesh Sood, M.D.Sunil Katyal, M.D.Avtar Singh, M.D.
Navneet Narula, M.D.Suneet Kathuria, M.D.
Tej K. Kaul, M.D.Anju Grewal, M.D.
Dayanand Medical College and HospitalLudhiana, India
Accepted for publication February 19, 2002.doi:10.1053/rapm.2002.33553
Reply to Sood et al.
To the Editor:We greatly appreciate the comments by Sood et al. on
our article1 and regret the confusion of “medial” and“lateral” due to a typing error.
Under the circumstances described by Sood et al. theconvention to test vibration sensation over the medialmalleolus in India makes sense, especially when used forneurologic diagnosis. In our German population we didnot notice any differences between measurements at thelateral or medial malleolus.
Moreover, motor block was gone at the time vibrationperception returned to baseline even in those patientswith moderately reduced vibration perception on base-line but no known polyneuropathy or other neurologicdisorder.
We would like to stress the importance of a carefulhistory and physical examination before using vibrationsense recovery as a tool to determine recovery from epi-dural neuraxial block to exlude patients with neurologicdisorders that might interfere with vibration sensationindependently of the neuraxial block.
Reference
1. Schulz-Stubner S, Zingel E, Rossaint R. Vibration sense test-ing with a 128-Hz tuning fork as a tool to determinerecovery from epidural neuraxial block. Reg Anesth PainMed 2001;26:518-522.
Sebastian Schulz-Stubner, M.D.2084 Timber Lane
Coralville, Iowa 52241
Accepted for publication March 25, 2002.doi:10.1053/rapm.2002.33981
Letters to the Editor 447