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Continuing Education in Anaesthesia, Critical Care & Pain 2006 6(1):32-36; doi:10.1093/bjaceaccp/mki065
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Continuing Education in Anaesthesia, Critical Care & Pain | Volume 6 Number 1 2006 © The Board of Management and Trustees of the British Journal of Anaesthesia [2006]. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org

Electrical nerve locators

Phil Dalrymple, Specialist Registrar in Anaesthesia and Intensive Care Medicine
Department of Anaesthetics, University Hospitals of Leicester NHS Trust, Leicester General Hospital, Gwendolen Road, Leicester LE5 4PW, UK

Subbiah Chelliah, Consultant Anaesthetist
Department of Anaesthetics, University Hospitals of Leicester NHS Trust, Leicester General Hospital, Gwendolen Road, Leicester LE5 4PW, UK
Tel: 0116 2584661 Fax: 0116 2584661 E-mail: sleepist@hotmail.com (for correspondence)

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Key points

Knowledge of applied anatomy, pharmacology, physics and competent procedural technique are essential requirements for consistently safe peripheral nerve blockade.

Nerve fibres of differing morphology require differing minimum pulse widths.

Evidence of a complete electrical circuit must be ascertained before needle advancement.

Incorrect electrode polarity may increase the required current strength considerably.

Muscle twitches obtained at <0.2 mA may indicate intraneural needle placement.

 

Peripheral nerve blockade for the purposes of intraoperative and postoperative analgesia has developed over the years into a common clinical procedure. Successful regional anaesthesia of this type depends upon precise location of the peripheral nerve or nerve plexus. Electrical stimulation of a peripheral nerve usually results in muscular twitching, paraesthesia or a combination depending on the nerve morphology. An electrical nerve locator (ENL) will stimulate muscular twitching at a close distance to the nerve without actually touching it; hence, providing greater accuracy for local anaesthetic deposition. . . . [Full Text of this Article]


   Electro-physiological factors affecting nerve stimulation
 
Current strength and pulse width

Distance from current stimulus to nerve

Electrode polarity


   Electrical nerve locating equipment
 
Current generator (Fig. 3)

Constant current output

Current meter

Current output control

Pulse width

Connection/disconnection indicator

Nerve blockade specific

Choice of stimulating frequency

Stimulating needles


   Performing a nerve block
 

   Percutaneous electrode guidance
 

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