50th Annual Regional Anesthesiology and Acute Pain Medicine Meeting

IMPROVING BLOCK PROPERTIES DURING PERIPHERAL NERVE BLOCK BY ELECTRICAL NEUROMODULATION: A CASE SERIES

•Peripheral nerve stimulation (PNS) during nerve blocks may improve onset, duration, and efficacy by optimizing sodium channel states for better local anesthetic (LA) binding, based on the Hille Modulated Receptor Theory (Hille et al., 1977).

•Traditional methods rely on muscle contractions to induce neural activity, which can be inconsistent and unreliable (Stevens et al., 1996).

•Local anesthetic resistance remains an underrecognized challenge in regional anesthesia, potentially leading to failed blocks and inadequate pain control.

•Direct nerve stimulation provides a more controlled and precise way to enhance nerve blockade without depending on muscle responses and may help overcome LA resistance by promoting more effective sodium channel modulation

This case series determines the impact of PNS-assisted peripheral nerve blocks (PNB) on block quality and pain management and their potential role in mitigating LA resistance.

The average onset for both sensory and motor blocks was 4.2 minutes, lasting approximately 15.6 hours. Most patients experienced minimal postoperative pain, with only one requiring opioids (a chronic pain patient on preoperative opioids). Five patients resistant to LAs had similar block profiles, including timely onset, good surgical block, and prolonged analgesia.
This promising hybrid system of increasing the stimulating current during PNB may improve block quality, especially in patients resistant to LAs, probably by enhancing the blockade through modulation of sodium channel states. This approach could improve PNB outcomes while potentially influencing central pain pathways for enhanced neural blockade and pain management.

50th Annual Regional Anesthesiology and Acute Pain Medicine Meeting

IMPROVING BLOCK PROPERTIES DURING PERIPHERAL NERVE BLOCK BY ELECTRICAL NEUROMODULATION: A CASE SERIES

Poster Presenter

Authors

Affiliations

Part of Topic