Nerve Localization: Paresthesia or Nerve Stimulation

The debate over which technique, paresthesia or nerve stimulation, is safer and more effica-cious is moot. The debate must be limited only to brachial plexus blockade, as the use of paresthesia techniques in infraclavicular, lumbar plexus, femoral, sciatic, popliteal, and other "deep" blocks is both unreliable and unacceptable in modern practice. Consequently, modern regional anesthesia practice is nearly impossible without nerve stimulators. Most recent published reports in the field describe the use of nerve stimulators in their methods.

The question of whether eliciting paresthesia or nerve stimulation is safer in brachial plexus blockade though, still continue to be debated by some researchers. Selander and Plevak suggest that the paresthesia technique increases the risk of postblock neuropathies. Indeed, the frequency of postanesthesia neuropathy was significantly greater when paresthesia techniques were utilized, as compared with "nonparesthesia" techniques. On the other hand, careful use of the paresthesia technique to localize the brachial plexus is successfully used at many centers without a significant increase in the risk of nerve injury. The major drawback of the paresthesia technique is that it is associated with greater patient discomfort. It is much more difficult to teach, as compared to nerve stimulator technique.

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DISCLAIMER: The material presented on this Web page has not been peer-reviewed. The indications, techniques and dosages on this Web page have been recommended in the medical literature and/or conform to OUR clinical practice. The medications and equipment have not necessarily been approved by the Food and Drug Administration (FDA) for use in the techniques and dosages for which they are recommended. The package insert for each drug and/or equipment should be consulted for use and dosage as recommended by the FDA. Because standards, practices and recommendations change, it is advisable to keep abreast of revised recommendations, particularly those concerning new drugs and techniques. While the techniques and dosages described are successfully used in our practice, they should be followed with a discretion since their complications may be dependent on the operator, patient and/or other accompanying clinical circumstances. The development and maintenance of this web page has not been supported by any pharmaceutical or medical manufacturing industry. The medications and/or equipment discussed in the web page is shown solely for teaching purposes. Similar equipment or medications from other manufacturers may produce similar clinical results to ours.