Interactive system and method for peripheral nerve mapping and blocking

• US 7,104,965 B1
• Filed: 06/06/2003
• Issued: 09/12/2006
• Est. Priority Date: 06/06/2003
• Status: Expired due to Fees

• Current Assignee: The General Hospital Corporation (Mass General Brigham, Inc.)
• Original Assignee: The General Hospital Corporation (Mass General Brigham, Inc.)
• Inventors: George, Edward, Sunder, Neelakant, Jiang, Yandong
• Primary Examiner(s): Hindenburg, Max F.
• Assistant Examiner(s): DRYDEN, MATTHEW DUTTON
• Application Number:
  US10/456,823
• Time in Patent Office: 1,194 Days
• Field of Search: 600/554, 600/386, 600/390, 600/393, 600/372, 606/32, 606 33- 41, 607/115, 607/116
• US Class Current: 600/554
• CPC Class Codes: A61B 5/05 Detecting, measuring or recording for diagnosis by means of electric currents or magnetic fields; Measuring using microwaves or radio waves impedance plethysmography A61B5/0295; measuring movement of the entire body or parts thereof A61B5/11; detecting, measuring or recording bioelectric or biomagnetic signals of the body or parts thereof A61B5/24
• CPC Class Codes: A61B 5/4519 Muscles A61B5/389, A61B5/224 take precedence
• CPC Class Codes: A61B 5/4893 Nerves
• CPC Class Codes: A61N 1/36034 specified by the stimulation parameters

Abstract

A system for providing nerve mapping in human patients, which includes a processor coupled to a pulse generator and to a multi-position switch. The system further includes a conductive needle having a first end adapted for insertion into tissue and a second end coupled to a negative terminal of the pulse generator. A plurality of electrodes are disposed on the skin of the patient in a ring arrangement for defining a bounded area. Each electrode is selectively coupled to a positive terminal of the pulse generator, via the multi-position switch. In this arrangement, at least one pulse can be applied to the first end of the conductive needle while the conductive needle is positioned in the bounded area to form a communication relationship between the first end of the conductive needle and at least one of the plurality of electrodes for exciting a nerve located in the bounded area.

Claims

1. A system for providing nerve mapping, the system comprising:

a processor;

a pulse generator coupled to the processor;

a conductive needle having a first end adapted for insertion into tissue and a second end coupled to a first terminal of the pulse generator;

a switch having an input, a control input and a plurality of outputs, the input being coupled to a second terminal of the pulse generator and the control input being coupled to the processor; and

a plurality of electrodes arranged into a ring defining a bounded area and each being coupled to a corresponding one of the plurality of outputs of the switch, wherein the control input is adapted to receive a plurality of control signals from the processor for selectively coupling the second terminal of the pulse generator to one of the plurality of electrodes, and wherein at least one pulse is applied to the first end of the needle while the conductive needle is positioned in the bounded area to form a communication relationship between the first end of the needle and at least one of the plurality of electrodes for exciting a nerve located in the bounded area.

2. The system of claim 1, further comprising a video image display coupled to the processor and being adapted to provide at least one image depicting a proximity of the first end of the needle and the nerve.

3. The system of claim 1, further comprising a non-conductive medium adapted to retain each of the plurality of electrodes in the ring and having a predetermined spacing relative to each other for defining the bounded area.

4. The system of claim 1 wherein the conductive needle comprises a control for adjusting an energy value of the at least one pulse to permit a minimal energy value to be applied to the first end of the needle to excite the nerve.

5. The system of claim 1 wherein the at least one pulse comprises a pulse width ranging from approximately 0.1 milli-seconds to approximately 0.5 milli-seconds.

6. The system of claim 5 wherein the at least one pulse comprises a current output ranging from approximately zero milli-amperes to approximately 2 milli-amperes.

7. The system of claim 1 wherein the switch comprises a solid-state switch.

8. The system of claim 1 wherein the switch comprises a multiplexor.

9. A method for providing nerve mapping, the method comprising:

(a) applying at least one pulse to a first end of a conductive needle while positioning the conductive needle at a predetermined position in a region of tissue bounded by a plurality of electrodes for forming a communication relationship between the first end of the conductive needle and at least one electrode of the plurality of electrodes to excite a predetermined nerve located in the region of the tissue bounded by the plurality of electrodes; and

(b) measuring at least one actual muscle contraction between the first end of the needle and the at least one electrode of the plurality of electrodes in response to excitation of the predetermined nerve.

10. The method of claim 9 wherein prior to applying the at least one pulse, the method further comprises determining a proximate nerve blocking location on the region of tissue for which the predetermined nerve is to be blocked.

11. The method of claim 10 further comprising disposing the plurality of electrodes on the nerve blocking location in a ring arrangement to form the region of the tissue bounded by the plurality of electrodes.

12. The method of claim 11, further comprising defining a proximate depth “

d”

at which the predetermined nerve is to be blocked.

13. The method of claim 12 wherein positioning the conductive needle at the predetermined position located in the region of tissue bounded by the plurality of electrodes comprises inserting the first end of the conductive needle to the proximate depth “

d.”

14. The method of claim 9 wherein measuring the at least one actual muscle contraction comprises comparing the at least one actual muscle contraction to a model muscle contraction.

15. The method of claim 14, further comprising determining if the at least one actual muscle contraction substantially matches the model muscle contraction.

16. The method of claim 15 wherein if it is determined that the at least one actual muscle contraction substantially matches the model muscle contraction, the method further comprising determining a relative spatial relationship between the first end of the conductive needle and the predetermined nerve.

17. The method of claim 16, further comprising determining a distance value between the first end of the conductive needle and the predetermined nerve.

18. The method of claim 17, further comprising processing the relative spatial relationship and the distance value to generate a needle position image displaying a relative proximity of the first end of the conductive needle to the predetermined nerve.

19. The method of claim 18, further comprising moving the first end of the needle under interactive guidance of the needle position image to a nerve blocking position for administration of a nerve blocking agent.

20. The method of claim 15 wherein if it is determined that the at least one actual muscle contraction does not substantially match the model muscle contraction, the method further comprises moving the tip of the needle to another predetermined position in the region of tissue bounded by the plurality of electrodes and repeating steps (a) and (b).

21. The method of claim 14 wherein comparing the at least one actual muscle contraction to the model muscle contraction comprises comparing the at least one actual muscle contraction to a rendering of the model muscle contraction.

22. The method of claim 21 wherein comparing the at least one actual muscle contraction to the rendering of the model muscle contraction comprises comparing the at least one actual muscle contraction to the model muscle contraction rendered on a display.

23. A method for nerve mapping comprising:

a. arranging a plurality of electrodes to form a bounded region on a surface;

b. positioning a conductive needle within the bounded region;

c. providing a first conductive path between the conductive needle and a first one of the plurality of electrodes;

d. applying at least one electrical pulse to the bounded region through the conductive needle; and

e. measuring a first nerve response through the first conductive path;

f. providing a second conductive path between the conductive needle and a second one of the plurality of electrodes;

g. applying an additional at least one electrical pulse to the bounded region through the conductive needle; and

h. measuring a second nerve response through the second conductive path.

24. The method of claim 23 wherein measuring the first nerve response and measuring the second nerve response comprises comparing muscle contractions to model muscle contractions.

25. The method of claim 24 wherein comparing muscle contractions to model muscle contractions comprises comparing muscle contractions to renderings of the model muscle contractions.