Der Anaesthesist

, Volume 63, Issue 5, pp 422–428 | Cite as

Lokalisation peripherer Nerven

Erfolg und Sicherheit mit elektrischer Nervenstimulation
  • M. Neuburger
  • U. Schwemmer
  • T. Volk
  • W. Gogarten
  • P. Kessler
  • T. Steinfeldt
Regionalanästhesie

Zusammenfassung

Die periphere elektrische Nervenstimulation ist neben der Ultraschalltechnik das Standardverfahren zur Durchführung der Blockade peripherer Nerven. In den letzten Jahren sind u. a. durch die Visualisierung von Nadel und Nerv mit Ultraschall während der Blockade klinisch bedeutsame neue Erkenntnisse über die elektrische Nervenstimulation in den Vordergrund gerückt. Im vorliegenden Beitrag werden die alten und neuen Erkenntnisse in den Grundlagen sowie der Anwendung der Nervenstimulationstechnik dargestellt und in einen klinischen Gesamtkontext gebracht, um sichere und erfolgreiche periphere Blockaden mit der elektrischen Nervenstimulation durchzuführen.

Schlüsselwörter

Nervenblockade Regionalanästhesie Reizstrom Reizschwelle Nadeln 

Localization of peripheral nerves

Success and safety with electrical nerve stimulation

Abstract

Peripheral electrical nerve stimulation is one of the standard applications in peripheral regional anesthesia in addition to the ultrasound technique. Among other findings, the visualization of needle and nerve during ultrasound-guided blockade caused a change in clinical practice of peripheral nerve stimulation in the last decade. In the present article old and new aspects of principles and clinical practice of the nerve stimulation technique are presented and summarized in a total clinical concept in order to achieve safe and successful peripheral regional anesthesia using electrical peripheral nerve stimulation.

Keywords

Nerve block Regional anesthesia Current Threshold Needles 

Notes

Einhaltung der ethischen Richtlinien

Interessenkonflikt. M. Neuburger: kein Konflikt; T. Steinfeldt: Vortragshonorar von B.Braun, Teleflex, Vygon; U. Schwemmer: kein Konflikt; T. Volk: Vortragshonorare, Forschungsprojekte, Unterstützung zu Fortbildungsveranstaltungen von Abbott, Abbvie, Agesa, Archimedes Pharma, Arrow, Astra Zeneca. Baxter, Bayer, B.Braun, Biotest, CareFusion, CSL Behring, Dr. Köhler Chemie, ewimed, FreseniusKabi, GE, Grünenthal, GSK, Mitsubishi, MLP, MSD, MundiPhanma, Novartis, Novo Nordisk, Orion Pharrna, Pfizer, Pall Medical, Pulsion, Sanofi, THCPharm, Thermo Scientific, Vifor Pharma; W. Gogarten: kein Konflikt; P. Kessler: Vortragshonorar von B.Braun, CSL-Behring. Der Beitrag enthält keine Studien an Menschen oder Tieren.

Literatur

  1. 1.
    Auroy Y, Benhamou D, Bargues L et al (2002) Major complications of regional anesthesia in France: the SOS regional anesthesia hotline service. Anesthesiology 97:1274–1280PubMedCrossRefGoogle Scholar
  2. 2.
    Bigeleisen P, Moayeri N, Groen G (2009) Extraneural versus intraneural stimulation thresholds during ultrasound-guided supraclavicular block. Anesthesiology 110:1235–1243PubMedCrossRefGoogle Scholar
  3. 3.
    Birnbaum J, Klotz E, Bogusch G et al (2007) Elektrische Nervenstimulation für Plexus- und Nervblockaden. Anaesthesist 56:1155–1162PubMedCrossRefGoogle Scholar
  4. 4.
    Brull R, McCartney CJ, Chan VW, El-Beheiry H (2007) Neurological complications after regional anesthesia: contemporary estimates of risk. Anesth Analg 104:965–974PubMedCrossRefGoogle Scholar
  5. 5.
    Chan V, Brull R, McCartney C et al (2007) An ultrasonographic and histologic study of intraneural injection and electrical stimulation in pigs. Anesth Analg 104:1281–1284PubMedCrossRefGoogle Scholar
  6. 6.
    Chin J, Tsui BC (2010) No change in impedance upon intravascular injection of D5W. Can J Anaesth 57:559–564PubMedCrossRefGoogle Scholar
  7. 7.
    Choyce A, Chan VW, Middleton WJ et al (2001) What is the relationship between paresthesia and nerve stimulation for axillary brachial plexus block? Reg Anesth Pain Med 26:100–104PubMedCrossRefGoogle Scholar
  8. 8.
    Engelhardt L, Grosse J, Birnbaum J et al (2007) Inhibition of a pacemaker during nerve stimulation for regional anaesthesia. Anaesthesia 62:1071–1074PubMedCrossRefGoogle Scholar
  9. 9.
    Ercole A (2008) The effect of injectate conductivity on the electric field with the nerve stimulator needle: a computer simulation. Anesth Analg 107:1427–1432PubMedCrossRefGoogle Scholar
  10. 10.
    Ford DJ, Pither CE, Raj PP (1984) Comparison of insulated and uninsulated needles for locating peripheral nerves with a peripheral nerve stimulator. Anesth Analg 63:925–928PubMedGoogle Scholar
  11. 11.
    Franco CD, Vieira ZE (2000) 1001 subclavian perivascular brachial plexus blocks: success with a nerve stimulator. Reg Anesth Pain Med 25:41–46PubMedGoogle Scholar
  12. 12.
    Franco CD, Domashevich V, Voronov G et al (2004) The supraclavicular block with a nerve stimulator: to decrease or not to decrease, that is the question. Anesth Analg 98:1167–1171PubMedCrossRefGoogle Scholar
  13. 13.
    Hadzic A, Vloka J, Hadzic N et al (2003) Nerve stimulators used for peripheral nerve blocks vary in their electrical characteristics. Anesthesiology 98:969–974PubMedCrossRefGoogle Scholar
  14. 14.
    Hadzic A, Vloka JD, Claudio R et al (2004) Electrical nerve localization: effects of cutaneous electrode placement and duration of the stimulus on motor response. Anesthesiology 100:1526–1530PubMedCrossRefGoogle Scholar
  15. 15.
    Jochum D, Iohom G, Diarra DP et al (2006) An objective assessment of nerve stimulators used for peripheral nerve blockade. Anaesthesia 61:557–564PubMedCrossRefGoogle Scholar
  16. 16.
    Johnson CR, Barr RC, Klein SM (2007) A computer model of electrical stimulation of peripheral nerves in regional anesthesia. Anesthesiology 106:323–330PubMedCrossRefGoogle Scholar
  17. 17.
    Kaiser H, Niesel HC, Hans V (1990) Grundlagen und Anforderungen der peripheren elektrischen Nervenstimulation. Ein Beitrag zur Erhöhung des Sicherheitsstandards in der Regionalanästhesie. Reg Anaesth 13:143–147PubMedGoogle Scholar
  18. 18.
    Kaiser H, Niesel HC, Hans V et al (1990) Untersuchungen zur Funktion peripherer Nervenstimulatoren für die Durchführung von Nerv- und Plexusblockaden. Reg Anaesth13:172–178Google Scholar
  19. 19.
    Kaiser H, Niesel HC, Klimpel L et al (1992) Prilocaine in lumbosacral plexus block: general efficacy and comparison of nerve stimulation amplitude. Acta Anaesthesiol Scand 36:692–697PubMedCrossRefGoogle Scholar
  20. 20.
    Kaiser H, Neuburger M (2002) How close is close enough – how close is safe enough. Reg Anesth Pain Med 27:227–278PubMedCrossRefGoogle Scholar
  21. 21.
    Klein SM, Melton MS, Grill WM et al (2012) Peripheral nerve stimulation in regional anesthesia. Reg Anesth Pain Med 37:383–392PubMedCrossRefGoogle Scholar
  22. 22.
    Koscielniak-Nielsen ZJ, Rassmussen H, Jepsen K (2001) Effect of impulse duration on patients’ perception of electrical stimulation and block effectiveness during axillary block in unsedated ambulatory patients. Reg Anesth Pain Med 26:428–433PubMedCrossRefGoogle Scholar
  23. 23.
    Koscielniak-Nielsen ZJ (2006) Multiple injections in axillary block: where and how many? Reg Anesth Pain Med 31:192–195PubMedCrossRefGoogle Scholar
  24. 24.
    LaBan MM, Petty D, Hauser AM et al (1988) Peripheral nerve conduction stimulation: its effect on cardiac pacemakers. Arch Phys Med Rehabil 69:358–362PubMedGoogle Scholar
  25. 25.
    Li J, Kong X, Gozani SN et al (2011) Current-distance relationships for peripheral nerve stimulation localization. Anesth Analg 112:236–241PubMedCrossRefGoogle Scholar
  26. 26.
    Lullies H, Trincker D (1973) Taschenbuch der Physiologie II, 2. Aufl. Gustav Fischer, StuttgartGoogle Scholar
  27. 27.
    MacFarlane AJ, Bhatia A, Brull R (2011) Needle to nerve proximity: what do the animal studies tell us? Reg Anesth Pain Med 36:290–302PubMedCrossRefGoogle Scholar
  28. 28.
    Mulroy MF, Mitchell B (2002) Unsolicited paresthesias with nerve stimulator: case reports of four patients. Anesth Analg 95:762–763PubMedGoogle Scholar
  29. 29.
    Neal JM, Bernards CM, Hadzic A et al (2008) ASRA practice advisory on neurologic complications in regional anesthesia and pain medicine. Reg Anesth Pain Med 33:404–415PubMedCentralPubMedCrossRefGoogle Scholar
  30. 30.
    Neuburger M, Rotzinger M, Kaiser H (2001) Elektrische Nervenstimulation in Abhängigkeit von der benutzten Impulsbreite. Eine quantitative Untersuchung zur Annäherung der Nadelspitze an den Nerv. Anaesthesist 50:181–186PubMedCrossRefGoogle Scholar
  31. 31.
    Neuburger M, Gültlinger O, Ass B et al (2005) Influence of blockades with local anesthetics on the stimulation ability of a nerve by peripheral nerve stimulation. Results of a randomized study. Anaesthesist 54:575–577PubMedCrossRefGoogle Scholar
  32. 32.
    Neuburger M, Kaiser H (2009) Nicht ohne meinen Nervenstimulator. In: Eckart, Jäger, Möllhoff: Anästhesiologie EcoMed (Kapitel 6.2.9), 15. Ergänzungslieferung, S 1–22Google Scholar
  33. 33.
    Perlas A, Niazi A, McCartney C et al (2006) The sensitivity of motor response to nerve stimulation and paresthesia for nerve localization as evaluated by ultrasound. Reg Anesth Pain Med 31:445–450PubMedCrossRefGoogle Scholar
  34. 34.
    Perthes G (1912) Über Leitungsanästhesie unter Zuhilfenahme elektrischer Reizung. Münch Med Wochenschr 47:2545–2551Google Scholar
  35. 35.
    Rigaud M, Filip P, Lirk P et al (2008) Guidance of block needle insertion by electrical nerve stimulation. Anesthesiology 109:473–478PubMedCentralPubMedCrossRefGoogle Scholar
  36. 36.
    Robards C, Hadzic A, Somasundaram L et al (2009) Intraneural injection with low-current stimulation during popliteal sciatic nerve block. Anesth Analg 109:673–677PubMedCrossRefGoogle Scholar
  37. 37.
    Sala Blanch X, López AM, Carazo J et al (2009) Intraneural injection during nerve stimulator-guided sciatic nerve block at the popliteal fossa. Br J Anaesth 102:855–861CrossRefGoogle Scholar
  38. 38.
    Sauter AR, Dodgson MS, Kalvoy H et al (2009) Current threshold for nerve stimulation depends on electrical impedance of the tissue. Anesth Analg 108:1338–1343PubMedCrossRefGoogle Scholar
  39. 39.
    Sharma AK, Thomas PK (1974) Peripheral nerve structure and function in experimental diabetes. J Neurol Sci 23:1–15PubMedCrossRefGoogle Scholar
  40. 40.
    Silverstein WB, Saiyed MU, Brown AR (2000) Interscalene block with a nerve stimulator: a deltoid motor response is a satisfactory endpoint for successful block. Reg Anesth Pain Med 25:356–359PubMedGoogle Scholar
  41. 41.
    Sites BD, Gallagher J, Sparks M (2003) Ultrasound-guided popliteal block demonstrates an atypical motor response to nerve stimulation in 2 patients with diabetes mellitus. Reg Anesth Pain Med 28:479–482PubMedCrossRefGoogle Scholar
  42. 42.
    Steinfeldt T, Graf J, Schneider J et al (2011) Histological consequences of needle-nerve contact following nerve stimulation in a pig model. Anesthesiol Res Pract. 2011:591851. DOI 10.1155/2011/591851Google Scholar
  43. 43.
    Steinfeldt T, Graf J, Vassiliou T et al (2009) High or low current threshold for nerve stimulation for regional anaesthesia. Acta Anaesthesiol Scand 53:1275–1281PubMedCrossRefGoogle Scholar
  44. 44.
    Sung DH (2004) Locating the target nerve and injectate spread in rabbit sciatic nerve block. Reg Anesth Pain Med 29:194–200PubMedCrossRefGoogle Scholar
  45. 45.
    Szerb J, Persaud D (2005) Long current impulses may be required for nerve stimulation in patients with ischemic pain. Can J Anaesth 52:963–966PubMedCrossRefGoogle Scholar
  46. 46.
    Tsai TP, Vuckovic I, Dilberovic F et al (2008) Intensity of the stimulating current may not be a reliable indicator of intraneural needle placement. Reg Anesth Pain Med 33:207–210PubMedCrossRefGoogle Scholar
  47. 47.
    Tsui BC, Wagner A, Finucane B (2004) Electrophysiologic effect of injectates on peripheral nerve stimulation. Reg Anesth Pain Med 29:189–193PubMedCrossRefGoogle Scholar
  48. 48.
    Tsui BC, Kropelin B (2005) The electrophysiological effect of dextrose 5 % in water on single-shot peripheral nerve stimulation. Anesth Analg 100:1837–1839PubMedCrossRefGoogle Scholar
  49. 49.
    Tsui BC, Pillay JJ, Chu KT et al (2008) Electrical impedance to distinguish intraneural from extraneural needle placement in porcine nerves during direct exposure and ultrasound guidance. Anesthesiology 109:479–483PubMedCrossRefGoogle Scholar
  50. 50.
    Urmey WF, Grossi P (2002) Percutaneous electrode guidance: a noninvasive technique for prelocation of peripheral nerves to facilitate peripheral plexus or nerve block. Reg Anesth Pain Med 27:261–267PubMedGoogle Scholar
  51. 51.
    Urmey WF, Stanton J (2002) Inability to consistently elicit a motor response following sensory paresthesia during interscalene block administration. Anesthesiology 96:552–554PubMedCrossRefGoogle Scholar
  52. 52.
    Urmey WF, Grossi P (2006) Use of sequential electrical nerve stimuli (SENS) for location of the sciatic nerve and lumbar plexus. Reg Anesth Pain Med 31:463–469PubMedCrossRefGoogle Scholar
  53. 53.
    Vassiliou T, Müller HH, Ellert A et al (2013) High- versus low-stimulation current threshold for axillary plexus blocks: a prospective randomized triple-blinded noninferiority trial in 205 patients. Anesth Analg 116:247–254PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  • M. Neuburger
    • 1
  • U. Schwemmer
    • 2
  • T. Volk
    • 3
  • W. Gogarten
    • 4
  • P. Kessler
    • 5
  • T. Steinfeldt
    • 6
  1. 1.Abteilung für Anästhesie und IntensivmedizinOrtenau Klinikum AchernAchernDeutschland
  2. 2.Klinik für Anästhesiologie und IntensivmedizinKliniken des Landkreises Neumarkt i.d.OPf.Neumarkt i.d.OPf.Deutschland
  3. 3.Klinik für Anästhesiologie, Intensivmedizin und SchmerztherapieUniversitätsklinikum des SaarlandesHomburgDeutschland
  4. 4.Klinik für Anästhesiologie, operative Intensivmedizin, Notfallmedizin und SchmerztherapieKlinikum BielefeldBielefeldDeutschland
  5. 5.Klinik für Anästhesiologie, Intensiv- und SchmerzmedizinOrthopädische Universitätsklinik FriedrichsheimFrankfurt a. M.Deutschland
  6. 6.Klinik für Anästhesie und IntensivtherapieUKGM Gießen-Marburg, Standort MarburgMarburgDeutschland

Personalised recommendations