The use of the PNS as an aid to nerve localization has an accepted place in the practice of regional anesthesia. Several good stimulators are now commercially available, with many features to aid successful blockade. These include a constant current output with clear reading meter, variable linear output, clearly marked polarity, and short pulse width. For these devices to be used optimally, however, a sound knowledge of the electrophysiology of the technique is important. This includes an appreciation of the strength-duration curve, current distance relationship, and preferential cathodal stimulation. Good technique is necessary to optimize the successful performance of the PNS; therefore, attention should be given to the electrical behavior of the type of needle used, the minimal current required to stimulate the nerve, and the correct use of the injection of a small test dose of local anesthetic.
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