Should Nerve Stimulation Be Taught to Trainees??!
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- Опубликовано: 8 авг 2023
- In this shocking (get it?) and fun pro-con debate, co-hosts of the "Block It Like It's Hot" podcast Jeff Gadsden and Amit Pawa battle it out to try to convince YOU that nerve stimulation should (or should not) be part of the curriculum for trainees learning peripheral nerve block techniques. Intense? Yup. Full of controversy? Of course. Entertaining? Always.
Put your vote for who won the debate in the comments below!
The real trigger warning is not for ripping the wire off, it was for all that ultrasound footage of nerve kebabing that came right afterwards lol.
That was painful to watch...🤯
This is so so awesome. Can't ever thank you enough for how much I enjoy seeing whatever you two have to teach. Super fan hehe
Aww thanks for watching, BlockerGirl!! We love your content too!!
Great video,very helpful, thank you so much for sharing your experience and your deep knowledge or RA
Glad it was helpful! Thanks for watching!
Great video as the others. It would be interesting a short video guide of the evocated motor response after stimulation of the major nerves. Great works!!!
That’s a great idea-consider it on the list!
I absolutely agree with Jeff. These days, there is always the excuse that if you don't have a large double blind study, you shouldn't do it. Medicine's time honored approach to treatments has always been "do no harm," ...not to do nothing that's not published via a double blind study. As Jeff mentioned, if you can do everything possible to prevent even a 1 in 5000 injury, or even if you don't prevent it, but tried with all reasonable effort, then I feel...and I have to presume a reasonable peer on a jury would likely agree that you did the best you could with all equipment available to try and avert a life changing disaster. It helps me sleep better at night knowing that I did everything possible to "do no harm." I think patients appreciate that effort, even if it does take an extra minute.
thank you so much!!!
Thanks so much for watching!
Great video.
I think you both win. I agree with both but with nuances.
Really the difference is how do you teach it? or, how do you do it regularly?
Personally, I teach with a nerve stimulator (you give your trainee more information). But I do it regularly without a nerve stimulator.
Great work for both. Nice to hear it on the way to the WCRA in Paris
Thanks Vicente!! Really appreciate you listening! Agree with your point about the value for the trainee versus the experienced clinician. Hope you’re well and enjoy Paris!!
This video is so good that I feel guilty for watching it free.
Wait, you didn't pay the fee?! Haha, just kidding. Glad you enjoyed it, really appreciate you watching!!
Great information, thanks for your hard work!
Glad it was helpful! Thanks for watching!
Dr. Gadsden what nerve stimulator setting do you use to stimulate the muscle? it is possible to use the muscle stimulation for FICB?
I usually turn the current intensity up to at least 1.5-2.0 mA. You don't want a subtle twitch--you want obvious muscle stimulation. I haven't used it for FICB but that makes a lot of sense! That might keep you out of the iliacus muscle and in the correct plane, just like in QL or ESP. Let me know how it works for you, and thanks for watching!
I tried but it didn t work 😕 Two points: what amplitude , duration and frequency is optimal to use? is it critical to put anode at least 20 cm to cathode (needle) ?
Very informative. Additionally, if I'm working this out correctly/logically, practically in my mind, to use the US and nerve stimulator, you'd need and extra pair of hands. So nit only mire equipment(which I'm not really upset about), but requiring more human resources...mmmm .. I'd opt out of the stimulator.
Depends. Set to 0.2-0.3ma, and block as per normal - get a twitch when you weren't expecting one? You might have just avoided a kebab. You can use your USS hand to tweak the settings if you want. If you're a self injector, you're already resourceful enough to do this. If you have an assistant, you've got someone to tweak already. The only reason for not using PNS is if you can't be bothered, or don't have one.
Thanks for watching! We tend to set up the stimulator with a current intensity of 0.6-0.8 mA, then place it nearby and carry on with the US-guided block. If we see/feel a twitch, that’s a sign we’re relatively close to the nerve-we re-assess the needle tip position and reposition if necessary. So it doesn’t really need an extra hand so to speak. Hope that helps!
@@nerveblock"Might" being the key word. It also might have added no value wahtsoever.
@@joestevenson5568 I think it will most likely regularly add value, with the expectation being you would rarely get unexpected responses, if otherwise, perhaps there's bigger issues.
For TAP block, will you adjust the current to 4 mAmp? will be the end point, only disappearing of int ob muscle contraction? . What if we only 1.2 mAmp current?
Usually I'll get a direct muscle contraction with current intensity of 1.5 mA or greater. You don't have to go all the way to 4 mA. The goal is to just confirm that you're either in the muscle or out. I love that you're using this technique for TAP blocks!
@@regionalanesthesiology ever since I read this comment I've been using nerve stimulator for my TAP and Rectus Sheath blocks and it changed my perspective on things
I'm with using nerve stimulator , to be honest
It's brilliant ( it's my school)😂
YES
Promo*SM ☹️
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