![]() Even with ultrasound guidance, nerve stimulation is often helpful to confirm that the structure imaged is actually the nerve that is sought. The motor response (twitch) to PNS is objective, reliable and independent from the patient’s (subjective) response. ![]() An unexpected motor response during needle advancement may alert the operator that the needle is in immediate vicinity to the nerve and therefore, prevent further needle advancement when the needle tip position is not well seen on ultrasound. When used with ultrasound guidance, PNS becomes primarily a safety tool. The goal of nerve stimulation is to place the tip of the needle (more specifically, its orifice for injection) in close proximity to the target nerve to inject the local anesthetic within the tissue space that contains the nerve. In principle, almost all plexuses or other large peripheral nerves can be located using PNS. More recently, ultrasound guidance in combination with nerve stimulation (“dual monitoring”) has become a common practice to guide needle placement and robust medicolegal documentation of nerve block procedures. The use of nerve stimulation can recognize an intraneural or intrafascicular needle placement injection, prevent further needle advancement intraneurally and help reduce the risk of nerve injury.Įlectrical nerve stimulation can be used for a single-injection technique, as well as for guidance during the insertion of continuous nerve block catheters. What Is Electrical Peripheral Nerve Stimulation?Įlectrical nerve stimulation in regional anesthesia is a method of using a low-intensity (up to 5 mA) and short-duration (0.05 to 1 ms) electrical stimulus (at 1- to 2-Hz repetition rate) to obtain a defined response (muscle twitch or sensation) to locate a peripheral nerve or nerve plexus with an (insulated) needle before injecting local anesthetic in close proximity to the nerve to block nerve conduction for surgery or acute pain management. The more widespread introduction of nerve stimulation in the practice of peripheral nerve block led to research on the needle-nerve relationship and the effect of stimulus duration. More recently, the principles of electrical nerve stimulation were applied to surface mapping of peripheral nerves using percutaneous electrode guidance for confirmation and epidural catheter placement and peripheral catheter placement. This chapter discusses the electrophysiology of nerve stimulation, electrical nerve stimulators, various modes of localization of peripheral nerves, and integration of the technology into the realm of ultrasound-guided regional anesthesia. It took nearly 100 years from the concept of nerve stimulation to adoption of electrolocalization during peripheral nerve block in the 1990s.
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