From the Research
Intraoperative monitoring of the sciatic nerve during hip replacement surgery is best accomplished using a handheld nerve stimulator, as it facilitates surgical decision-making and can potentially prevent sciatic nerve injury, as demonstrated in a study published in 2018 1.
Key Considerations
- The use of a handheld nerve stimulator allows for real-time assessment of nerve function, enabling immediate corrective action to be taken before nerve injury occurs.
- This method is particularly useful in complex primary total hip arthroplasty requiring limb lengthening and/or significant manipulation of the sciatic nerve.
- The stimulator can detect changes in nerve response, which can inform intraoperative decision-making, such as altering the surgical plan to avoid nerve injury.
Comparison with Other Methods
- Other studies have investigated the use of multimodal intraoperative monitoring, including somatosensory evoked potentials (SSEPs) and electromyography (EMG) 2, 3, 4.
- However, the most recent and highest quality study, published in 2018, supports the use of a handheld nerve stimulator as a effective method for intraoperative monitoring of the sciatic nerve 1.
Anesthesia Management
- Anesthesia must be carefully managed to ensure accurate monitoring signals, with total intravenous anesthesia using propofol and remifentanil preferred over volatile anesthetics.
- Muscle relaxants should be avoided or used minimally to allow for EMG responses.
Clinical Implications
- The use of a handheld nerve stimulator for intraoperative monitoring of the sciatic nerve can help reduce the risk of nerve injury and improve outcomes in hip replacement surgery.
- This method can be particularly useful in complex cases, such as those requiring significant limb lengthening or nerve manipulation.