Background and Objectives. The NerveSeeker is a new instrument for locating peripheral nerves. Like existing nerve stimulators, it is based on injecting current through the needle used for drug injection. However, the NerveSeeker was designed to automatically adjust the amplitude of the stimulating current pulses. It does this by feedback control to hold the level of response constant at a small but reliably detectable fraction of a maximal neural response. We report experimental tests of the NerveSeeker using an excised frog nerve in a transparent chamber, where we could observe the needle approach.
Methods. A control voltage proportional to the stimulus magnitude was used to indicate the proximity of the needle tip to the nerve. The proximity was validated by direct measurement of the distance from the tip of the needle to the nerve. Parameters governing the performance of the NerveSeeker in tracking needle movement were analyzed.
Results. The following combined strategy was found effective: As the needle approached the nerve, the stimulus was reduced in proportion to the amplitude of the recorded response; as the needle moved away, the stimulus magnitude was incremented by a constant amount (enough to increase the neural response by approximately 1% of its maximum amplitude) after each stimulus that failed to elicit a neural response exceeding the criterion value. Stimulation throughout simulated penetrations was at a frequency of 10 Hz or higher to give more immediate guidance during insertion. Optimal settings for each control parameter were determined, reflecting both engineering and physiologic tradeoffs. With these settings, the device proved successful in localizing nerves, closely tracking needle movements at velocities as high as 2 mm/second.
Conclusion. These experimental results suggest that clinical tests of the NerveSeeker would be appropriate.
- Nerve stimulators
- nerve localization
- regional block.
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Supported by the Brigham and Women's Hospital Anesthesia Foundation and by NIGMS GM 35647.