Peripheral nerve stimulation in regional anesthesia.

Published

Journal Article (Review)

Peripheral nerve stimulation has a long history in regional anesthesia. Despite the advent of ultrasound-guided peripheral nerve blockade, nerve stimulation remains a popular technique used alone or, now, in combination with ultrasound-guided techniques. In light of this evolving utility of nerve stimulation, this is an appropriate time to review the basic concepts and knowledge base of this historically important tool. Electrical nerve stimulation facilitates nerve localization, using threshold current as a surrogate for needle-to-nerve distance. Preferential activation of motor nerves is possible because motor nerve fibers are more readily activated with a shorter duration of current compared with sensory nerves. The association between current and needle-to-nerve distance predicts that less current is needed to evoke a motor response as the needle moves closer to the nerve. Thus, an elicited motor response at or below 0.5 mA is considered a common end point for successful neural blockade. However, current magnitude is neither 100% sensitive nor specific. Independent of technical ability, both the biological environment and the equipment used impact the current-distance relationship. Thus, successful electrical nerve stimulation is dependent on an anesthesiologist with a solid foundation in anatomy and a thorough understanding of electrophysiology.

Full Text

Duke Authors

Cited Authors

  • Klein, SM; Melton, MS; Grill, WM; Nielsen, KC

Published Date

  • July 2012

Published In

Volume / Issue

  • 37 / 4

Start / End Page

  • 383 - 392

PubMed ID

  • 22683706

Pubmed Central ID

  • 22683706

Electronic International Standard Serial Number (EISSN)

  • 1532-8651

Digital Object Identifier (DOI)

  • 10.1097/AAP.0b013e3182576647

Language

  • eng

Conference Location

  • England