Nerve Localization

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.