Abstract
The diagnostic nerve block (DNB) for spasticity is the percutaneous application of
an anesthetic to an individual peripheral nerve trunk (mixed motor sensory nerve),
nerve branch to a muscle or an intramuscular branch. The DNB causes a temporary paralysis
to assess the contribution of muscle(s) on the spastic pattern and may unmask a fully
or partially increased joint range of motion. The anesthetic literature supports the
use of ultrasound (US) guidance to improve nerve blocks for sensory targets. This
communication summarizes the potential advantages that support the use of US to improve
DNB technique. Nerves are much smaller than muscle targets and have various known
innervation patterns. US allows for rapid localization of the target before injection,
particularly in complex anatomy patterns. The nerve trunks are typically found adjacent
to or encapsulating blood vessels, which can be quickly identified with or without
color Doppler, allowing the clinician to scan from the vessels to the target and avoid
intravascular injection. Lower stimulation levels can be used as the targeted muscle(s)
can be seen stimulating rather than only on the surface. A shorter needle insertion
time and lower stimulation levels should cause less discomfort to the patient. Smaller
volumes of anesthetic may be used as the fluid is seen reaching its target and cessation
of stimulation is observed. Further study is needed to identify evidence supporting
US utilization with electrical stimulation in DNBs for spasticity management, as US
use during nerve blocks for perineurial anesthesia has demonstrated improved patient
safety and procedural efficiency.
Keywords
List of abbreviations:
DNB (diagnostic nerve block), e-stim (electrical stimulation), US (ultrasound)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: February 03, 2023
Accepted:
January 16,
2023
Received in revised form:
January 13,
2023
Received:
July 25,
2022
Publication stage
In Press Journal Pre-ProofFootnotes
Disclosures: Dr Winston has a publishing contract to produce a Textbook on this topic. Dr Winston has received honoraria and institutional funding from Pacira, AbbVie, Merz, Ispen. Dr Reebye has received honoraria and institutional funding from Pacira, AbbVie, Merz, Ispen. Dr Picelli and Dr Reebye have received honoraria and institutional funding from AbbVie, Merz, Ipsen. Dr David has received honoraria and institutional funding from AbbVie, Merz, Ipsen. Dr Boissonnault has received honoraria and institutional funding from Pacira, AbbVie, Merz, Ispen.
Identification
Copyright
© 2023 by the American Congress of Rehabilitation Medicine.
