Practice patterns in the use of peripheral nerve stimulators in peripheral nerve blockade. a national survey

J. D. Vloka, A. Hadsis, M. M. Kuroda, R. Koorn, D. J. Birnbach

Research output: Contribution to journalArticle

2 Scopus citations

Abstract

Introduction: Although peripheral nerve stimulators (PNS) have become indispensable as clinical and teaching tools in regional anesthesia practice, techniques for their use appear to vary widely among anesthesiologists. In a national survey, we assessed the techniques of peripheral nerve blockade (PNB) with the aid of PNS. Methods: Questionnaires were mailed to 683 randomly selected American anesthesiologists regarding the use of peripheral nerve blocks in their practices. Responses from anesthesiology attendings who reported that they perform PNBs in their practices were analyzed with respect to PNS utilization. Results: Among the 413 attending anesthesiologists who responded to the survey (a response rate of 60.5%), 268 (64.8%) reported that they use PNS when performing PNB. Although the majority (54.8%) set their initial current between 0.3 mA and 1.0 mA, 34.7% use settings outside this range and 10.4% use the PNS without current display (Figure 1). More than half (59.3%) achieve the optimal current on the PNS by selecting a high current initially and then decreasing the current according to the response elicited as the needle is advanced toward the nerve. Fewer anesthesiologists (32.7%) select a low current initially and then increase the current according to the elicited response. Nearly all anesthesiologists using PNS (81.5%) either always, or most of the time, seek the lowest current at which the response is still obtainable. Among those who perform more than 10 PNBs per month, 36% always seek the lowest stimulating current, and 47.4% do so most of the time. Anesthesiologists who perform more than 10 PNBs per month are more likely to manipulate the current output than anesthesiologists who less frequently perform PNBs (24.7% vs. 18%;p=0.008). Discussion: Our results indicate that American anesthesiologists do not follow a uniform technique when using PNS during PNB. Initial current settings vary as does the manner in which the optimal current is sought. Further studies designed to evaluate the efficiency of the various approaches are warranted as they may maximize the effectiveness of PNS in performing PNBs.

Original languageEnglish (US)
Number of pages1
JournalRegional Anesthesia
Volume22
Issue number2 SUPPL.
StatePublished - Dec 1 1997
Externally publishedYes

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine

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