Nerve Stimulators in Perioperative Anesthesia

Nerve stimulators are tools that are primarily used in perioperative regional anesthesia to accurately locate peripheral nerves, enhancing the safety and efficacy of nerve blocks. By delivering low-intensity electrical impulses, nerve stimulators help anesthesiologists identify motor responses that indicate specific nerve territories. They enable the precise placement of local anesthetic, which minimizes complications such as intraneural injections and ensures adequate anesthesia with lower drug volumes.

Although using nerve stimulators on their own can demonstrably improve procedural outcomes, they can also be used concurrently with ultrasound-guided nerve blocks. Combining ultrasound with nerve stimulation has demonstrated superior outcomes in terms of block success rates and patient safety. Recent anatomical investigations have shown that ultrasound-guided PNS targeting the femoral, iliohypogastric, and ilioinguinal nerves can enhance block precision without increasing the risk of nerve injury (1).

Beyond nerve localization, the emerging use of peripheral nerve stimulation (PNS) suggests benefits in postoperative pain management and autonomic function modulation. For instance, vagus nerve stimulation (VNS) is increasingly being studied in surgical contexts, not only for chronic neurological conditions but also as a potential intervention for postoperative fatigue and inflammation. One study of elderly patients undergoing colorectal cancer surgery suggested that perioperative VNS could modulate inflammatory pathways and reduce postoperative fatigue syndrome. This opens a new area of research in neuromodulation for surgical recovery, highlighting a growing interest in using autonomic modulation to improve surgical outcomes (2).

Nerve stimulator use is not without risks. Case reports have highlighted rare but serious complications, such as asystole and laryngospasm following vagus nerve stimulator generator replacement. These complications can be caused by excessive vagal activation during surgery (3). These findings emphasize the importance of meticulous intraoperative monitoring and a comprehensive understanding of the device’s physiological effects when used perioperatively.

Technological advancements in nerve stimulators have expanded the range of conditions for which they can be used, including for perioperative anesthesia. The American Society of Pain and Neuroscience has endorsed 60-day peripheral nerve stimulation therapy for managing acute and subacute pain, with applications extending into the perioperative setting (4). These devices provide a non-opioid approach to pain management, which is particularly relevant in the context of the opioid crisis. Short-term peripheral nerve stimulation therapies can be tailored to individual patients and integrated into enhanced recovery after surgery protocols, which could reduce reliance on systemic analgesics and improve patient satisfaction.

Additionally, perioperative nerve stimulation may impact cardiovascular stability through autonomic modulation. A systematic review emphasized the impact of autonomic nervous system imbalance on surgical outcomes. This review suggests that targeted nerve stimulation could mitigate perioperative complications related to sympathetic overdrive, including hypertension, arrhythmias, and delayed recovery (5). As more evidence emerges, the therapeutic scope of nerve stimulators in perioperative anesthesia may expand beyond nerve localization and analgesia to include modulation of systemic responses to surgical stress.

Nerve stimulators play a multifaceted role in perioperative anesthesia, from guiding regional blocks to managing postoperative pain and influencing autonomic dynamics. Although technological advancements and clinical guidelines have improved their safety profile, careful patient selection and device-specific considerations are still essential. Continued research is essential to understanding their full capabilities and integrating them into comprehensive perioperative care strategies.

References

1. Cho JS, Grisham A, Wang A, et al. Focused Anatomic Review: Ultrasound-Guided Peripheral Nerve Stimulation of the Femoral, Iliohypogastric, and Ilioinguinal Nerves. Pain Med. Published online April 24, 2025. doi:10.1093/pm/pnaf047
2. Yin X, Qiao S, Zhang L, et al. New intervention strategy for postoperative fatigue syndrome in elderly patients with colorectal cancer: a clinical hypothesis study based on vagus nerve stimulation. Front Med (Lausanne). 2025;12:1588850. Published 2025 Jun 2. doi:10.3389/fmed.2025.1588850
3. Manohara N, Byrappa V, Maiti T, Jain A, Lobo FA. Asystole and Laryngospasm After Vagal Nerve Stimulator Generator Replacement: A Case Report. A A Pract. 2025;19(5):e01967. Published 2025 May 1. doi:10.1213/XAA.0000000000001967
4. Gill B, Tidwell C, Hagedorn JM, et al. Consensus Guidelines from the American Society of Pain and Neuroscience for the Use of 60-Day Peripheral Nerve Stimulation Therapy. A NEURON Living Guideline Project. J Pain Res. 2025;18:3117-3139. Published 2025 Jun 24. doi:10.2147/JPR.S521788
5. Pan WT, Ji MH, Ma D, Yang JJ. Effect of perioperative autonomic nervous system imbalance on surgical outcomes: a systematic literature review. Br J Anaesth. Published online July 3, 2025. doi:10.1016/j.bja.2025.06.004