Elektrische Nervenstimulation für Plexus- und Nervenblockaden

Abstract

Despite the increasing use of ultrasound, electrical nerve stimulation is commonly used as the standard for both plexus and peripheral nerve blocks. Several recent randomized trials have contributed to a better understanding of physiological and clinical correlations. Traditionally used currents and impulse widths are better defined in relation to the distance between needle tip and nerves. Commercially available devices enable transcutaneous nerve stimulation and provide new opportunities for the detection of puncture sites and for training. The electrically ideal position of the needle usually is defined by motor responses which can not be interpreted without profound anatomical knowledge. For instance, interscalene blocks can be successful even after motor responses of deltoid or pectoral muscles. Infraclavicular blocks should be aimed at stimulation of the posterior fascicle (extension). In contrast to multiple single nerve blocks, axillary single-shot blocks more commonly result in incomplete anaesthesia. Blockade of the femoral nerve can be performed without any nerve stimulation if the fascia iliaca block is used. Independently of the various approaches to the sciatic nerve, inversion and plantar flexion are the best options for single-shot blocks. Further clinical trials are needed to define the advantages of stimulating catheters in continuous nerve blocks.

Efficacy of Continuous Femoral Nerve Block with Stimulating Catheters Versus Nonstimulating Catheters - A Systematic-Narrative Review

“…Neuro-stimulation and stimulating catheters, were the basis for perfecting continuous femoral blocks. While usually a simple technique, with minimal risks, occasionally, even in experienced hands, stimulating catheters present several shortcomings: lack of placement time consistency, increased costs, lack of direct visualization of local anesthetic spread, variability in stimulating catheter design and quality, uncertainty about nerve stimulation endpoints ( Hayek, 2006;Jack et al, 2005;Morin et al, 2005;Salinas et al, 2004;Birnbaum et al, 2007). An alternative for assisting with correct catheter placement is ultrasonographic guidance (Fig.…”

Elektrische Nervenstimulation bei peripheren Nervenblockaden

“…Im Allgemeinen kann man da von ausgehen, dass herkömmliche Stan dardverfahren unter Zuhilfenahme der Nervenstimulation mit guten Erfolgsra ten und hoher Sicherheit für Patienten durchgeführt werden können [3]. Durch die Nutzung geringer Stromstärken wird versucht, eine motorische Antwort im Zielgebiet der zu blockierenden Ner ven hervorzurufen.…”