In this post, I link to and embed Nerve Stimulation with Ultrasound? – Crash course with Dr. Hadzic, 15:11, Nov 17, 2021, from NYSORA-Education.
Many practitioners have abandoned the use of nerve stimulation in conjunction with ultrasound-guided nerve blocks. The commonly used rationale for dispensing with nerve stimulation is that stimulation is not needed, because the needle-nerve relationship can be seen on ultrasound.
However, multiple studies have documented that intraneural injection can occur with ultrasound alone. In a study by Krediet (RAPM, 2014), even experts missed 1 out of 6 intraneural injections. In this video, Dr. Hadzic argues for the rationale of using nerve stimulation with ultrasound as a standard additional monitoring tool for safety. This is different than the role of nerve stimulation in nerve localization, as it used to be used before the introduction of ultrasound in PNBs.
He then makes a strong case for the routine use of nerve stimulation as he demonstrates its value in several clinical cases and argues that the occurrence of an unexpected distal motor response to nerve stimulation in those cases may have contributed to the patients’ safety. Finally, documenting the absence of a motor response at 0.5 mA (0.1 msec) represents a very strong medico-legal document, as the response is either present or absent. In contrast, ultrasound images are subject to interpretation and are therefore difficult to document.
