The evolution of Intraoperative Neuromonitoring (IONM) in peripheral nerve surgery, dating back to the 1960s, has been motivated by the regenerative capabilities of peripheral nerves and the pursuit of refined surgical techniques. This chapter explores the significance of the Seddon and Sunderland Classifications in guiding surgical decision-making for nerve injuries, emphasizing the variability in procedures based on factors like anatomical location and approach. It delves into peripheral nerve anatomy, highlighting how the extent of injury dictates alternative surgical approaches, and discusses tools such as Nerve Action Potentials (NAPs), Compound Muscle Action Potentials (CMAPs), Transcranial Motor Evoked Potentials (TcMEPs), and Somatosensory Evoked Potentials (SSEPs) for assessing nerve conduction as well as motor and sensory function. This chapter covers various surgical techniques, including neurolysis, nerve grafting, and nerve transfer, introducing innovative approaches like targeted muscle reinnervation (TMR) and targeted sensory reinnervation (TSR). Continuous monitoring, incorporating various modalities, is crucial for comprehensive intraoperative feedback. The conclusion emphasizes pelvic nerve monitoring, underscoring the growing importance of preserving neural structures in pelvic surgeries. In summary, this review offers a concise historical perspective of IONM, providing valuable insights into evolving techniques and technological considerations that enhance the precision of these intricate surgical procedures.