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Pressure Monitoring of Intraneural an Perineural Injections Into the Median, Radial, and Ulnar Nerves; Lessons From a Cadaveric Study.

Krol A, Szarko M, Vala A, De Andres J - Anesth Pain Med (2015)

Bottom Line: Intraneural needle placement produced significantly greater pressures than perineural injections did.Obtained results demonstrate significant differences between intraneural and perineural injection pressures in the median, ulnar, and radial nerves.Intraneural injection pressures show low specificity but high sensitivity suggesting that pressure monitoring might be a valuable tool in improving the safety and efficacy of peripheral nerve blockade in regional anesthesia.

View Article: PubMed Central - PubMed

Affiliation: Department of Anaesthesia and Chronic Pain Service, St Georges Hospital, London, United Kingdom.

ABSTRACT

Background: Nerve damage after regional anesthesia has been of great concern to anesthetists. Various modalities have been suggested to recognize and prevent its incidence. An understudied area is the measurement of intraneural pressure during peripheral nerve blockade. Previous investigations have produced contradicting results with only one study being conducted on human cadavers.

Objectives: The purpose of this investigation was to systematically record intraneural and perineural injection pressures on the median, ulnar, and radial nerves exclusively as a primary outcome.

Materials and methods: Ultrasonography-guided injections of 1 mL of 0.9% NaCl over ten seconds were performed on phenol glycerine embalmed cadaveric median, ulnar, and radial nerves. A total of 60 injections were performed, 30 intraneural and 30 perineural injections. The injections pressure was measured using a controlled disc stimulation device. Anatomic dissection was used to confirm needle placement.

Results: Intraneural needle placement produced significantly greater pressures than perineural injections did. The mean generated pressures in median, radial, and ulnar nerves were respectively 29.4 ± 9.3, 27.3 ± 8.5, and 17.9 ± 7.0 pound per square inch (psi) (1 psi = 51.7 mmHg) for the intraneural injections and respectively 7.2 ± 2.5, 8.3 ± 2.5, and 6.7 ± 1.8 psi for perineural injections. Additionally the intraneural injection pressures of the ulnar nerve were lower than those of the median and radial nerves.

Conclusions: Obtained results demonstrate significant differences between intraneural and perineural injection pressures in the median, ulnar, and radial nerves. Intraneural injection pressures show low specificity but high sensitivity suggesting that pressure monitoring might be a valuable tool in improving the safety and efficacy of peripheral nerve blockade in regional anesthesia. Peripheral nerves "pressure mapping" hypothetically might show difference amongst various nerves depending on anatomic location, histologic structure, and ultrasonographic appearance.

No MeSH data available.


Related in: MedlinePlus

The Measurements Obtained From the Controlled Disc Stimulation DeviceIntraneural and perineural injection pressures are shown on the left and right columns, respectively.
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fig17956: The Measurements Obtained From the Controlled Disc Stimulation DeviceIntraneural and perineural injection pressures are shown on the left and right columns, respectively.

Mentions: The baseline pressure of injection of 1 mL of 0.9% NaCl at a rate of 0.1 mL/sec with 100-mm, 80-mm, and 50-mm 22-G needles showed no difference in pressure values (Table 1). All of the cadaveric dissections confirmed that the needle was positioned correctly (Figure 2). The CDS graphs produced following the injection of 1 mL of 0.9% NaCl in ten seconds are displayed in Figure 3. This data shows that intraneural placed needles produced a greater injection pressures in comparison to perineural injections across all three nerves. The means of generated pressures by intraneural and perineural injections into the median nerve were respectively 29.4 ± 9.3 and 7.2 ± 2.5 (P < 0.01). The means of generated pressures in the radial nerve through intraneural and perineural injections were respectively 27.3 ± 8.5 and 8.3 ± 2.5 psi (P < 0.01). The means of generated pressures in the ulnar nerve by intraneural and perineural injections were 17.9 ± 7.0 and 6.7 ± 1.8 psi (P < 0.01) (Figure 4). All perineural injections produced a pressure of < 12 psi. In contrast, all intraneural injections pressures for median nerve and all of that for radial nerves, except one measurement, were > 20 psi. These results are illustrated in Table 2 and Figure 4.


Pressure Monitoring of Intraneural an Perineural Injections Into the Median, Radial, and Ulnar Nerves; Lessons From a Cadaveric Study.

Krol A, Szarko M, Vala A, De Andres J - Anesth Pain Med (2015)

The Measurements Obtained From the Controlled Disc Stimulation DeviceIntraneural and perineural injection pressures are shown on the left and right columns, respectively.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4493739&req=5

fig17956: The Measurements Obtained From the Controlled Disc Stimulation DeviceIntraneural and perineural injection pressures are shown on the left and right columns, respectively.
Mentions: The baseline pressure of injection of 1 mL of 0.9% NaCl at a rate of 0.1 mL/sec with 100-mm, 80-mm, and 50-mm 22-G needles showed no difference in pressure values (Table 1). All of the cadaveric dissections confirmed that the needle was positioned correctly (Figure 2). The CDS graphs produced following the injection of 1 mL of 0.9% NaCl in ten seconds are displayed in Figure 3. This data shows that intraneural placed needles produced a greater injection pressures in comparison to perineural injections across all three nerves. The means of generated pressures by intraneural and perineural injections into the median nerve were respectively 29.4 ± 9.3 and 7.2 ± 2.5 (P < 0.01). The means of generated pressures in the radial nerve through intraneural and perineural injections were respectively 27.3 ± 8.5 and 8.3 ± 2.5 psi (P < 0.01). The means of generated pressures in the ulnar nerve by intraneural and perineural injections were 17.9 ± 7.0 and 6.7 ± 1.8 psi (P < 0.01) (Figure 4). All perineural injections produced a pressure of < 12 psi. In contrast, all intraneural injections pressures for median nerve and all of that for radial nerves, except one measurement, were > 20 psi. These results are illustrated in Table 2 and Figure 4.

Bottom Line: Intraneural needle placement produced significantly greater pressures than perineural injections did.Obtained results demonstrate significant differences between intraneural and perineural injection pressures in the median, ulnar, and radial nerves.Intraneural injection pressures show low specificity but high sensitivity suggesting that pressure monitoring might be a valuable tool in improving the safety and efficacy of peripheral nerve blockade in regional anesthesia.

View Article: PubMed Central - PubMed

Affiliation: Department of Anaesthesia and Chronic Pain Service, St Georges Hospital, London, United Kingdom.

ABSTRACT

Background: Nerve damage after regional anesthesia has been of great concern to anesthetists. Various modalities have been suggested to recognize and prevent its incidence. An understudied area is the measurement of intraneural pressure during peripheral nerve blockade. Previous investigations have produced contradicting results with only one study being conducted on human cadavers.

Objectives: The purpose of this investigation was to systematically record intraneural and perineural injection pressures on the median, ulnar, and radial nerves exclusively as a primary outcome.

Materials and methods: Ultrasonography-guided injections of 1 mL of 0.9% NaCl over ten seconds were performed on phenol glycerine embalmed cadaveric median, ulnar, and radial nerves. A total of 60 injections were performed, 30 intraneural and 30 perineural injections. The injections pressure was measured using a controlled disc stimulation device. Anatomic dissection was used to confirm needle placement.

Results: Intraneural needle placement produced significantly greater pressures than perineural injections did. The mean generated pressures in median, radial, and ulnar nerves were respectively 29.4 ± 9.3, 27.3 ± 8.5, and 17.9 ± 7.0 pound per square inch (psi) (1 psi = 51.7 mmHg) for the intraneural injections and respectively 7.2 ± 2.5, 8.3 ± 2.5, and 6.7 ± 1.8 psi for perineural injections. Additionally the intraneural injection pressures of the ulnar nerve were lower than those of the median and radial nerves.

Conclusions: Obtained results demonstrate significant differences between intraneural and perineural injection pressures in the median, ulnar, and radial nerves. Intraneural injection pressures show low specificity but high sensitivity suggesting that pressure monitoring might be a valuable tool in improving the safety and efficacy of peripheral nerve blockade in regional anesthesia. Peripheral nerves "pressure mapping" hypothetically might show difference amongst various nerves depending on anatomic location, histologic structure, and ultrasonographic appearance.

No MeSH data available.


Related in: MedlinePlus