The role of peripheral nerve stimulation in the era of ultrasound‐guided regional anaesthesia

Abstract

Summary With the widespread use of ultrasound for localising nerves during peripheral nerve blockade, the value of electrical nerve stimulation of evoked motor responses has been questioned. Studies continue to show that, compared with nerve stimulation, ultrasound guidance alone leads to: significantly improved block success; decreased need for rescue analgesia; decreased procedural pain; and lower rates of vascular puncture. Nerve stimulation combined with ultrasound does also not appear to improve block success rates, apart from those blocks where the nerves are challenging to view, such as the obturator nerve. The role of nerve stimulation has changed in the last 15 years from a technique to locate nerves to that of an adjunct to ultrasound. Nerve stimulation can serve as a monitor against needle‐nerve contact and may be useful in avoiding nerves that are in the needle trajectory during specific ultrasound guided techniques. Nerve stimulation is also a useful adjunct in teaching novices ultrasound‐guided regional anaesthesia, especially when the position and or appearance of nerves may be variable. In this review, the changing role of nerve stimulation in contemporary regional anaesthetic practice is presented and discussed.

Can different positions facilitate block application in ultrasound-guided obturator nerve block? A prospective comparative study

“…The most important factors hindering the success of peripheral nerve blockade are the difficulty of finding the "perfect point" and the inability to clearly determine the landmarks in nerve localization. To obtain the most appropriate ultrasound image, especially in the blockage of nerves that are difficult to reach and located deep, various positions are given to the patients [9][10][11][12].…”

Intertruncal versus classical approach to the ultrasound-guided supraclavicular brachial plexus block for upper extremity surgery: study protocol for a randomized non-inferiority trial

“…A recent cadaver study has reported that sub-perineural injections can be as high as 24% for a single intracluster injection [ 20 ]. As a result, it should be remembered that it cannot exclude direct or indirect nerve injuries even under real-time imaging of the needle-nerve distance [ 21 , 22 ]. Therefore, in clinical practice, it is eager to carry out a scheme to prevent nerve injuries and finding a more appropriate injection site will be better and safer according to the needs of inexperienced operators.…”

Advancing towards the next frontier in regional anaesthesia

“…The use of ultrasound in regional anaesthesia quickly progressed from simple assessment of injectate spread to needle-to-nerve guidance in conjunction with peripheral nerve stimulation, and it has now been established as the standard of practice in performing most peripheral nerve blocks [3]. Note that neurostimulation has not been entirely abandoned but rather repurposed for important secondary roles preventing intraneural injection and confirming the identity of nerve targets [4].…”