Surface mapping of peripheral nerves in children with a nerve stimulator

Abstract

Defining anatomical landmarks may be difficult in the growing child. With the aid of a peripheral nerve stimulator, the path of many superficial peripheral nerves can be 'mapped' prior to skin penetration by stimulating the motor component of the peripheral nerve percutaneously with a 2-3.5 mA output. The required current will vary and is dependent upon the depth of the nerve and the moistness of the overlying skin. This 'nerve mapping technique' has proved particularly useful for brachial plexus, axillary, ulna and median nerve blocks in the upper limb and femoral and popliteal nerve blocks in the lower limb. It is a useful teaching tool and improves the success rate of peripheral nerve blocks in children of all ages.

Descriptive study of the differences in the level of the conus medullaris in four different age groups

“…Classical anatomical landmarks might also be absent or difficult to define in children with congenital deformities (Bosenberg et al, 2002).…”

Percutaneous electrode guidance using the insulated needle for prelocation of peripheral nerves during axillary plexus blocks

“…10,11 Ultrasonography has been used for prelocating nerves, but this technique is not easily available in operating rooms, and the relation between blood vessels and nerves may vary from patient to patient. 8 In short reports, previous investigators have demonstrated that percutaneous electrode guid-ance eliciting either paresthesia 12 or motor responses [13][14][15][16] can be used to assist peripheral nerve block. These reports used either modified electrocardiograph electrodes, the negative electrode of a nerve stimulator, or a narrow sterile shielded cutaneous electrode prototype that allowed needle access through it or the needle tip itself, encased in plastic.…”

Regional anesthesia in children: the future

“…Pediatric anatomy is somewhat different and evolves as the child grows. On the positive side, most nerves are superficial and therefore can be better defined with high‐frequency ultrasound, and for those practitioners who are restricted to nerve stimulation, nerve mapping is also easier when nerves are superficial (16). While ultrasound guidance has virtually become the standard of care in the developed world, nerve stimulation still has its place.…”