Electrical Nerve Stimulation and Percutaneous Identification of the Target

  • L. Perotti
  • M. AllegriEmail author
  • A. Matteazzi
  • P. Grossi


The execution of a peripheral block requires a procedure that permits accurate identification of the nerve structures. The identification of a nerve or a nerve plexus for the purposes of performing a regional anesthetic block is done by means of invasive or noninvasive techniques using needles or other specific instruments.


Electrical nerve stimulation (ENS) Scientific basis of ENS Electrical nerve stimulators Percutaneous electrode guidance (PEG) PEG technique 



  1. Douglas Ford J, Pither C, Raj Prithvi P (1984) Comparison of insulated versus uninsulated needles for locating peripheral nerves with a peripheral nerve stimulator. Anesth Analg 63:925–928Google Scholar
  2. Duprè LJ (1992) Neurostimolateur en anesthésie Loco-régionale. Cahiers d’Anesthésiologie 40(7):503–510PubMedGoogle Scholar
  3. Ganta R, Cajee R, Henthorn R (1993) Use of transcutaneous nerve stimulation to assist interscalene block. Anesth Analg 76:914–915PubMedCrossRefGoogle Scholar
  4. Pither C, Raj PP, Douglas JF (1985) The use of peripheral nerve stimulators for regional anesthesia. A review of experimental characteristics, technique and clinical applications. Reg Anesth 10:49–58Google Scholar
  5. Shannon J, Lang S, Yip R (1995) Lateral femoral nerve block revisited: a nerve stimulator technique. Reg Anesth 20:100–104PubMedGoogle Scholar
  6. Smith BE (1990) The role of electrical nerve stimulation in regional anesthesia. Anesth Crit Care 1:234–238CrossRefGoogle Scholar
  7. Urmey W, Grossi P (2003) Percutaneous electrode guidance (PEG) and subcutaneous stimulating electrode guidance (SSEG): modifications of the original technique. Reg Anesth Pain Med 28:253–255PubMedCrossRefGoogle Scholar
  8. Urmey W, Grossi P (2002) Percutaneous electrode guidance (PEG): a noninvasive technique for pre-location of peripheral nerves to facilitate nerve block. Reg Anesth Pain Med 27:261–267PubMedGoogle Scholar
  9. Urmey W (2010) Electrical stimulation and ultrasound in regional anesthesia. Eur J Pain Supplement 4(4):319–322CrossRefGoogle Scholar
  10. Urmey W (1996) Upper extremity blocks. In: Brown D (ed) Regional anesthesia and analgesia. WB Saunders, Philadelphia, pp 254–278Google Scholar

Ultrasound-guided regional anesthesia

  1. Aromaa U, Lahdensuu M, Cozanitis DA (1997) Severe complications associated with epidural and spinal anesthesias in Finland 1987–1993. A study based on patient insurance claims. Acta Anaesthesiol Scand 41(4):445–452PubMedCrossRefGoogle Scholar
  2. De Tommaso O, Caporuscio A, Tagariello V (2002) Neurological complications following central neuraxial blocks: are there predictive factors? Eur J Anaesthesiol 19(10):705–716PubMedGoogle Scholar
  3. Denny NM, Harrop-Griths W (2005) Location, location, location! Ultrasound imaging in regional anesthesia. BMJ, pp 94: editorial IGoogle Scholar
  4. Grau T, Leipold RW, Horter J, Conradi R, Martin EO, Motsch J (2001) Paramedian access to the epidural space: the optimum window for ultrasound imaging. J Clin Anesth 13:213–217PubMedCrossRefGoogle Scholar
  5. Gray AT, Schafhalter-Zoppoth I (2003) Ultrasound guidance for ulnar nerve block in the forearm. Reg Anesth Pain Med 28(4):335–339PubMedGoogle Scholar
  6. Greher M, Kirchmair L, Enna B et al (2004) Ultrasound-guided lumbar facet nerve block: accuracy of a new technique confirmed by computed tomography. Anesthesiology 101(5):1195–1200PubMedCrossRefGoogle Scholar
  7. Greher M, Scharbert G, Kamolz LP et al (2004) Ultrasound-guided lumbar facet nerve block. Anesthesiology 100:1242–1248PubMedCrossRefGoogle Scholar
  8. Horlocker TT (2000) Complications of spinal and epidural anesthesia. Anesthesiol Clin North America 18(2):461–485PubMedCrossRefGoogle Scholar
  9. Kirchmair L, Entner T, Kapral S, Mitterschiffthaler G (2002) Ultrasound guidance for the psoas compartment block: an imaging study. Anesth Analg 94:706–710PubMedCrossRefGoogle Scholar
  10. La Grange P, Foster PA, Pretorius LK (1978) Application of the Doppler ultrasound blood flow detector in supraclavicular brachial plexus block. Br J Anaesth 50:965–967PubMedCrossRefGoogle Scholar
  11. Marhofer P, Greher M, Kapral S (2005) Ultrasound guidance in regional anesthesia. Br J Anaesth 94:7–17PubMedCrossRefGoogle Scholar
  12. Minville V, Zetlaoui PJ, Fessenmeyer C, Benhamou D (2004) Ultrasound guidance for difficult lateral popliteal catheter insertion in a patient with peripheral vascular disease. Reg Anesth Pain Med 29(4):368–370PubMedGoogle Scholar
  13. Moen V, Dahlgren N, Irestedt L (2004) Severe neurological complications after central neuraxial blockades in Sweden 1990–1999. Anesthesiology 101(4):950–959PubMedCrossRefGoogle Scholar
  14. Peterson MK, Millar FA, Sheppard DG (2002) Ultrasound-guided nerve blocks. Br J Anaesth 88(5):621–624PubMedCrossRefGoogle Scholar
  15. Puolakka R, Haasio J, Pitkanen MT et al (2000) Technical aspects and postoperative sequelae of spinal and epidural anesthesia: a prospective study of 3,230 orthopedic patients. Reg Anesth Pain Med 25(5):488–497PubMedGoogle Scholar
  16. Sandhu NS, Capan LM (2002) Ultrasound-guided infraclavicular brachial plexus block. Br J Anaesth 89:254–259PubMedCrossRefGoogle Scholar
  17. Schafhalter-Zoppoth I, Gray AT (2004) Ultrasound-guided nerve block in the presence of a superficial ulnar artery. Reg Anesth Pain Med 29(3):297–301PubMedGoogle Scholar
  18. Schafhalter-Zoppoth I, McCulloch CE, Gray AT (2004) Ultrasound visibility of needles used for regional nerve block: an in vitro study. Regional Anesth Pain Med 29(5):480–488CrossRefGoogle Scholar
  19. Sinha A, Chan VWS (2004) Ultrasound imaging for popliteal sciatic nerve block. Reg Anesth Pain Med 29(2):130–134PubMedGoogle Scholar
  20. Spence BC, Sites BD, Beach ML (2005) Ultrasound-guided musculocutaneous nerve block: a description of a novel technique. Reg Anesth Pain Med 30(2):198–201PubMedGoogle Scholar

Copyright information

© Springer-Verlag Italia 2014

Authors and Affiliations

  • L. Perotti
    • 1
  • M. Allegri
    • 2
    Email author
  • A. Matteazzi
    • 3
  • P. Grossi
    • 4
  1. 1.Anesthesia, Resuscitation and Pain Therapy ServiceIRCCS Foundation, Policlinico San Donato MilaneseSan Donato Milanese (MI)Italy
  2. 2.Anesthesia, Resuscitation and Pain Therapy ServiceIRCCS Policlinico San Matteo, PaviaPaviaItaly
  3. 3.Pain Therapy and Regional Therapy ServiceIRCCS, Policlinico San Donato MilaneseSan Donato Milanese (MI)Italy
  4. 4.Pain Therapy and Regional Anesthesia ServiceIRCCS, Policlinico San Donato MilaneseSan Donato Milanese (MI)Italy

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