Appropriate Location and Equipment

Ovid: Landmarks for Peripheral Nerve Blocks: Upper and Lower Extremities

Authors: Sciard, Didier A.; Matuszczak, Maria E.
Title: Landmarks for Peripheral Nerve Blocks: Upper and Lower Extremities, 2nd Edition
> Front of Book > Principles of Neurostimulation

Principles of Neurostimulation
Appropriate Location and Equipment
  • Room equipped with standard ASA monitors
  • Immediate access to resuscitative drugs and equipment
  • Equipment checked
  • Neurostimulators able to deliver a
    current of up to 5-mA intensity, frequency of 1 or 2 Hz (1 or 2
    impulses per second), impulse duration of 0.1 to 1 msec (0.1 to 0.3
    msec for a motor nerve stimulation and 1 msec for a sensory nerve
  • Insulated needles of 1, 2, 4, and 6 inches (2.5, 5, 10, and 15 cm)
  • Catheter sets with 2-, 4-, and 6-inch (5-, 10-, and 15-cm) introducer needles

  • Check nerve stimulator and connecting cables for their proper function.
  • Skin prep and local infiltrate for needle insertion.
  • Minimal distance between skin electrode and needle.
  • After skin puncture, gradually increase the intensity up to 1.5 mA at 0.3 msec.
  • Search in 3 axes (see picture on page x).
  • As soon as the first twitch is obtained,
    impulse duration (msec) should be decreased to 0.1 msec. Then intensity
    (mA) is slowly decreased while approaching the nerve to a minimal
    stimulation intensity of 0.5 to 0.3 mA.
  • Aspirate for blood.
  • Loss of motor response after injection of 1 mL of local anesthetic and return of the motor response when intensity is increased.
  • No resistance or pain during injection.
  • Slow and fragmented injection.



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