Many practitioners have abandoned the use of nerve stimulation in conjunction with ultrasound-guided nerve blocks. The commonly used rationale for dispensing with nerve stimulation is that stimulation is not needed, because the needle-nerve relationship can be seen on ultrasound.
However, multiple studies have documented that intraneural injection can occur with ultrasound alone. In a study by Krediet (RAPM, 2014), even experts missed 1 out of 6 intraneural injections. In this video, Dr. Hadzic argues for the rationale of using nerve stimulation with ultrasound as a standard additional monitoring tool for safety. This is different than the role of nerve stimulation in nerve localization, as it used to be used before the introduction of ultrasound in PNBs.
He then makes a strong case for the routine use of nerve stimulation as he demonstrates its value in several clinical cases and argues that the occurrence of an unexpected distal motor response to nerve stimulation in those cases may have contributed to the patients' safety. Finally, documenting the absence of a motor response at 0.5 mA (0.1 msec) represents a very strong medico-legal document, as the response is either present or absent. In contrast, ultrasound images are subject to interpretation and are therefore difficult to document.
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Disclaimer:
Medicine is an ever-changing science. As new research and clinical experience broaden, changes in treatment and drug therapy are required. The authors and publishers have checked with sources believed to be reliable in efforts to provide accurate information within the available or accepted standards of care. However, given the possibility of human error or changes in medical practice, neither the authors nor the publisher, nor any other party involved in the preparation of this platform warrants that the information contained herein is in every aspect accurate or complete, and they disclaim all responsibility for any errors or omissions for the results obtained from the use of the information contained in this work. Readers are advised to confirm the information contained herein with other sources. For example, readers are advised to check the product information of each drug mentioned, and that any information contained on NYSORA's RU-vid channel is accurate.
30 сен 2024
