Abstract
Most local anaesthetic blocks are placed blindly, based on a sound knowledge of anatomy. Very often the relationship between the site of deposition of local anaesthetic and the nerve to be blocked is unknown. Large motor neurons may be stimulated with the aid of an electrical current. By observing for muscle twitches, through electrical stimulation of the nerve, a needle can be positioned extremely close to the nerve. The accuracy of local anaesthetic blocks can be improved by this technique. By using the lowest possible current a needle could be positioned with in 2-5 mm of a nerve. The correct duration of stimulation ensures that stimulation of sensory nerves does not occur The use of electrical nerve stimulation in veterinary medicine is a novel technique that requires further evaluation.
Highlights
Local anaesthetic blocks are commonly used to provide peri-operative analgesia but are utilised for diagnostic and therapeutic procedures
In order to improve the accuracy of local anaesthetic blocks in unconscious or uncooperative humans, electrical nerve stimulation has been utilised to identify structures
This case study describes the utilisation of electrical nerve stimulation to perform a brachial plexus block
Summary
Local anaesthetic blocks are commonly used to provide peri-operative analgesia but are utilised for diagnostic and therapeutic procedures. The techniques for local anaesthetic blocks are based on an explicit knowledge of anatomical structures and their location. In order to improve the accuracy of local anaesthetic blocks in unconscious or uncooperative humans, electrical nerve stimulation has been utilised to identify structures. By observing the associated muscle twitches, one is able to identify the nerve to which the needle is closest. This case study describes the utilisation of electrical nerve stimulation to perform a brachial plexus block. As the needle approached the musculocutaneous nerve the muscles cranial to the shoulder twitched. By redirecting the needle and keeping the current flow low the position of the branch of the brachial plexus could be determined. The procedure was repeated until all the branches of the brachial plexus (median, radial and ulnar nerves) had been located. No adverse effects were observed during the anaesthetic period or during the postoperative period
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