Ten Minutes of Intraoperative Nerve Stimulation May Improve Outcomes Following End-to-End Nerve Transfer

Brief intraoperative electrical nerve stimulation (ES) has shown potential to improve outcomes of peripheral nerve surgery, including nerve repair, grafting, and transfer. This study compares clinical outcomes of nerve transfers receiving ES to those that did not.

Retrospective cohort study was performed of adults undergoing radial to axillary or median/ulnar to musculocutaneous nerve transfers at a single center between 2015 and 2025. Patients were divided into 2 groups: those who received 10 minutes of continuous ES (2 mA and 100 μs) intraoperatively (ES group) and those who did not (No ES group). Primary outcome was postoperative Medical Research Council motor grade. Chi-square tests were used to test associations between categorical variables and t tests for continuous measures.

Sixty surgeries (n = 44, no ES; n = 16, ES) in 46 patients were analyzed. Groups were similar in age (median 40 years, P = .622) and time to surgery (median 6 months, P = .261). Surgical characteristics were similar, including transfer type (P = .6884). All patients (n = 60) received end-to-end constructs. Among ES patients, 88% reached M4-M5 recovery versus 61% in nonstimulated patients (P = .136). Median follow-up was 26 months for no ES and 15 months for ES (P = .029). Controlling for age and time to surgery, stimulated patients were more likely to reach at least M4 (odds ratio 6.0, 95% confidence interval 1.03-35.34, P = .046).

Ten minutes of intraoperative ES may increase rates of excellent (M4-M5) motor recovery following end-to-end nerve transfer. Brief intraoperative ES is a readily implementable technique, requiring only 10 minutes of operative time, and represents a promising adjunct that may enhance outcomes for nerve transfers in brachial plexus reconstruction. Our practice has since adopted routine use of ES for nerve transfer surgeries.

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