Intraoperative Nerve Stimulation During Brachial Plexus Surgery: Comparison Between a Totally Disposable Nerve Stimulator and Nerve Stimulator Normally Used for Nerve Blocks

Thallaj, Ahmed; Alotaibi, Wadha; Alzahrani, Tariq; Abaalkhail, Abdulaziz S.; El-Sayed, Amel A. F.; Al‐Qattan, Mohammad M.

doi:10.1177/2292550317716120

Cited by 3 publications

(4 citation statements)

References 8 publications

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“…These stimulators deliver a stimulus in 0.1 mA increments, in the range of 0.1–5 mA. 6 During this nerve stimulation, the surgeon must instruct the anesthetist or circulating nurse to adjust the current.…”

Section: Discussionmentioning

confidence: 99%

Three Useful Tips and Tricks for Intraoperative Nerve Stimulation

Liu,

Raasveld,

Mayrhofer-Schmid

et al. 2024

Plastic and Reconstructive Surgery - Global Open

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Summary: Disposable handheld nerve stimulators are widely used in peripheral nerve surgery. Such devices stimulate a motor nerve or the motor component of a mixed nerve by applying electrical current to the proximal region, targeting the main nerve trunk. This stimulation then travels along the motor nerve, reaching the distal end to control the corresponding muscle(s). In this study, the authors demonstrate three useful tips and tricks for handheld nerve stimulation during targeted muscle reinnervation and peripheral nerve surgery. The three tips are (1) identification of proximal muscle contraction by retrograde electrical stimulation of a distal sensory nerve; (2) graded stimulation for identifying motor nerves within fibrotic scarred tissue beds or parallel to the major motor/mixed nerve of interest; and (3) proximal stimulation for validation of adequate post-targeted muscle reinnervation coaptation(s).

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Section: Discussionmentioning

confidence: 99%

Three Useful Tips and Tricks for Intraoperative Nerve Stimulation

Liu,

Raasveld,

Mayrhofer-Schmid

et al. 2024

Plastic and Reconstructive Surgery - Global Open

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“…For example, most disposable devices offer amplitudes of 0.5, 1.0, and 2.0 mA; some re-usable systems, such as those used for anesthesia blocks, offer up to 5.0 mA. 28 Other commercially available devices can produce up to 20 mA. Based on these findings, we believe that this technique may only be undertaken by those with access to higher amplitude intraoperative stimulation.…”

Section: Discussionmentioning

confidence: 99%

Early Simultaneous Cross Facial Nerve Graft and Masseteric Nerve Transfer for Facial Paralysis after Tumor Resection

Sergesketter

Shammas

Massa³

et al. 2023

Plastic and Reconstructive Surgery - Global Open

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Background: We describe a new approach for facial reanimation after skull base tumor resection with known facial nerve sacrifice, involving simultaneous masseter nerve transfer with selective cross facial nerve grafting (CFNG) within days after tumor surgery. This preliminary study compared outcomes of this approach versus a staged procedure involving a masseter nerve “babysitter” performed in a delayed timeline. Methods: Patients undergoing masseter nerve transfer and CFNG for facial paralysis after skull base tumor resection were consented to participate in video interviews. Facial Clinimetric Evaluation (FaCE) Scale (0–100) patient-reported outcome, eFACE, and Facial Grading Scale scores were compared. Results: Nine patients had unilateral facial paralysis from resection of a schwannoma (56%), acoustic neuroma (33%), or vascular malformation (11%). Five underwent early simultaneous CFNG and masseter nerve transfer (mean 3.6 days after resection), whereas four underwent two-stage reanimation including a babysitter procedure (mean 218 days after resection). Postoperative FaCE scale and Facial Grading Scale scores were similar in both groups (P > 0.05). Postoperative mean eFACE scores were similar for both groups for smile (early: 71.5 versus delayed: 75.5; P = 0.08), static (76.3 versus 82.1; P = 0.32), and dynamic scores (59.7 versus 64.9; P = 0.19); however, synkinesis scores were inferior in the early group (76.4 versus 91.1; P = 0.04). Conclusions: Early simultaneous masseter nerve transfer and CFNG provides reanimated movement sooner and in fewer stages than a staged approach in a delayed timeline. The early technique appears to result in similar clinician- and patient-reported outcomes compared with delayed procedures; however, in this preliminary study, the early approach was associated with greater synkinesis, meriting further investigation.

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“…Direct stimulation of nerve fibers is needed during the exploration of multiple nerve fibers, e.g., brachial plexus surgery, and fascicular orientation, e.g., nerve transfer techniques. [ 6 , 7 ] Monopolar devices, such as nerve stimulators that utilize a controlled electrical potential, are the most commonly used tools for this purpose. [ 8 , 9 ]…”

Section: Introductionmentioning

confidence: 99%

“…[2] Direct stimulation of nerve fibers is needed during the exploration of multiple nerve fibers, e.g., brachial plexus surgery, and fascicular orientation, e.g., nerve transfer techniques. [6,7] Monopolar devices, such as nerve stimulators that utilize a controlled electrical potential, are the most commonly used tools for this purpose. [8,9] Intraoperative direct supramaximal stimulation of an accessible peripheral nerve and quantifying the muscle innervated by this nerve may increase accuracy in assessing functional motor deficits.…”

mentioning

confidence: 99%

Neurostimulation in severe carpal tunnel release: A more precise technique for opponensplasty decision-making

Günsoy,

Dinç,

Cevdet Soydemir

2023

Jt Dis Relat Surg

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Objectives In this study, we aimed to investigate the relationship between intraoperative thenar muscle neurostimulation responses and postoperative thumb function recovery in patients with severe carpal tunnel syndrome (CTS). Patients and methods Between January 2019 and December 2021, a total of 21 severe CTS cases in 20 patients (7 males, 13 females; mean age: 56.3±19.3 years; range, 52 to 76 years) based on clinical and electrophysiological findings were retrospectively analyzed. The median nerve motor branch (MNMB) was stimulated intraoperatively with a nerve stimulator. The patients were divided into two groups according to contraction response on abductor pollicis brevis (APB) muscle: Group C (contractile, n=13) and Group NR (non-responsive, n=7) with and without muscular contraction. The Levine Functional Severity Scale (LFSS) was used to measure the functional status of CTS patients. The Manual Muscle Testing (MMT) was used to assess muscle strength. Clinical outcomes were compared between the groups at one year of follow-up. Results The mean total preoperative LFSS score was significantly higher in Group NR than in Group C (p=0.010). The mean postoperative MMT score was significantly higher in Group C than in Group NR (p<0.001). There was no positive result in pick-up, button fastening, and needle pinch tests in Group NR (p<0.001). However, there were significant improvements in postoperative LFSS scores in Group C (p<0.05), while the scores remained unchanged in Group NR (p>0.05). Conclusion Direct stimulation of the median nerve motor branch and observation of contraction response on APB muscle can be used to predict clinical recovery and facilitates making the decision for opponensplasty in severe CTS.

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Intraoperative Nerve Stimulation During Brachial Plexus Surgery: Comparison Between a Totally Disposable Nerve Stimulator and Nerve Stimulator Normally Used for Nerve Blocks

Abstract: Our center has stopped using the disposable nerve stimulator in favour for the anesthesia device.

Cited by 3 publications

References 8 publications

Three Useful Tips and Tricks for Intraoperative Nerve Stimulation

Three Useful Tips and Tricks for Intraoperative Nerve Stimulation

Early Simultaneous Cross Facial Nerve Graft and Masseteric Nerve Transfer for Facial Paralysis after Tumor Resection

Neurostimulation in severe carpal tunnel release: A more precise technique for opponensplasty decision-making

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