The role of electrical nerve stimulation in regional anaesthesia

Abstract

There is nothing in the whole of anaesthesia that quite compares with the swing from the elation that accompanies a successful regional anaesthetic technique, to the despair that may follow a failed block. The almost 100% success rate of intravenous induction of general anaesthesia makes it extremely difficult for any but the most stout hearted to accept the inevitable failures that occur with regional anaesthetic blocks. The key to all regional anaesthetic techniques is a sound knowledge of surface and neuro-anatomy, but it is this aspect that deters or even intimidates many anaesthetic trainees. In addition, the pressure on a trainee that results from working with the conscious patient may be severe. Lack of confidence by the anaesthetist is rapidly perceived by the patient, the surgeon and by other theatre staff, and this in turn becomes apparent to the anaesthetist. Faced by such a challenge the lure of thiopentone may be irresistable! If the risk of failure could be removed, or at least minimised, then regional anaesthesia would become a great deal more attractive to all concerned. Any technique that reduces the failure rate is to be welcomed, particularly if it also reduces the stress on the trainee and the patient.