[Electrical nerve stimulation for plexus and nerve blocks]

Area of Science:

• Anesthesiology
• Neurology
• Medical Devices

Context:

• Electrical nerve stimulation (ENS) remains a standard for plexus and peripheral nerve blocks, despite the rise of ultrasound.
• Recent randomized trials have enhanced understanding of physiological and clinical correlations in ENS.
• Currents and impulse widths in ENS are increasingly defined by needle-tip-to-nerve distance.

Purpose:

• To review the current understanding and application of electrical nerve stimulation in regional anesthesia.
• To highlight the importance of anatomical knowledge and specific motor responses for successful nerve blocks.
• To discuss advancements in nerve stimulation devices and their implications for puncture site detection and training.

Summary:

• ENS is crucial for nerve blocks, with optimal needle placement guided by motor responses and anatomical knowledge.
• Specific nerve blocks, such as infraclavicular and sciatic, have defined optimal stimulation targets and responses.
• Axillary single-shot blocks may lead to incomplete anesthesia, while femoral nerve blocks can be achieved via fascia iliaca block without ENS.

Impact:

• Improved understanding of ENS principles can enhance the efficacy and safety of regional anesthesia.
• Advances in transcutaneous nerve stimulation offer new training and detection methods.
• Further research is needed to evaluate the benefits of stimulating catheters for continuous nerve blocks.