Intraneural injection during nerve stimulator-guided sciatic nerve block at the popliteal fossa

Sala-Blanch, Xavier; López, A.M.; Carazo, J.L. Carazo; Hadžić, Admir; Carrera, Anna; Pomés, Jaume; Valls‐Solé, Josep

doi:10.1093/bja/aep097

Cited by 103 publications

(73 citation statements)

References 15 publications

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“…The 17% incidence of unintentional intraneural injection with ultrasound compares favourably with other guidance techniques. Although only small surveys for other guidance techniques are available (between 20 and 42 patients), these noted an 85% incidence of unintentional intraneural injection with anatomical landmark guidance for axillary block and an 88% incidence with nerve stimulator for popliteal block as noted on subsequent ultrasound imaging [11][12][13]. While it may , pages 168-174 .…”

Section: Discussionmentioning

confidence: 99%

Incidence of unintentional intraneural injection and postoperative neurological complications with ultrasound‐guided interscalene and supraclavicular nerve blocks*

Liu

YaDeau

Shaw³

et al. 2011

Anaesthesia

140

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SummaryIt is proposed that ultrasound guidance decreases the risk of intraneural injection and associated postoperative neurological complications. However, the incidence of unintentional intraneural injection with ultrasound is unknown. Two hundred and fifty-seven patients were enrolled in a prospective, single-blind observational study. All patients underwent a pre-operative neurological examination before ambulatory shoulder arthroscopy with sedation and ultrasound-guided interscalene or supraclavicular block. Patients were followed up at 1 week and at 4-6 weeks postoperatively. Two blinded anaesthesiologists viewed the same video of the ultrasound image during the block offline to determine intraneural trespass. Intraneural injection occurred in 42 patients (17%; 95% CI 12-22%). No patient suffered from postoperative neurological complications (0%; 95% CI 0-1.6%) at follow-up.

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Section: Discussionmentioning

confidence: 99%

Incidence of unintentional intraneural injection and postoperative neurological complications with ultrasound‐guided interscalene and supraclavicular nerve blocks*

Liu

YaDeau

Shaw³

et al. 2011

Anaesthesia

140

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“…It is accepted that nerve stimulation reduces the risk of direct needle trauma and intraneural injection as it informs the practitioner through the evoked motor responses before the needle contacts the nerve (7). In clinical practice of PNB where ultrasonography is not used, the most important indicators suggestive of intraneural injections are the practioner's feeling of high injection pressure during local anaesthetic injection and the sensation of pain and paresthesia experienced by the patient (6,7).…”

Section: Discussionmentioning

confidence: 99%

Femoral Nerve Injury Following a Lumbar Plexus Blockade

Güngör¹,

Zinnuroğlu²,

Taş³

et al. 2014

Balkan Med J

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Lumbar plexus block (LPB) in combination with sciatic nerve block (SNB) is a good alternative technique to general and neuroaxial anaesthesia providing intraoperative anaesthesia and postoperative analgesia in lower extremity operations. Severe complications associated with LPB mainly include systemic local anaesthetic toxicity, epidural spread of the local anaesthetic, total spinal block and retroperitoneal haematoma (1). Apart from these reported complications, femoral nerve injury (FNI) following LPB is a rarely encountered but clinically important complication (2).In this current case, we report on an FNI following a combined LPB and SNB for treatment of a patellar fracture. CASE PRESENTATIONA 44-year-old American Society of Anaesthesiologists (ASA) male patient, 175 cm tall and weighing 65 kg, was scheduled for an open reduction and internal fixation of a patellar fracture under combined LPB and SNB. A general physical examination and laboratory tests did not reveal any abnormalities. After informing the patient, the standard institutional written consent was obtained. Monitoring of cardiopulmonary parameters was performed. Midazolam (1 mg) and fentanyl (0.05 mg) were administered intravenously (iv) for sedation following the placement of a venous line. Afterwards, the patient was positioned in the lateral decubitus position with the side to be

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“…Recently, multiple reports have described clear intraneural injections of local anesthetic (as evidenced by ultrasound) in association with both low 1-3 and high 5,6,8 local anesthetic volume without subsequent prolonged clinical neurological deficit. [1][2][3][4][5][6] Consequently, this has led to the suggestion that injecting small volumes of local anesthetic beneath the epineurium but outside the perineurium is an acceptably safe practice.…”

Section: Discussionmentioning

confidence: 99%

Case report: Neurological deficit associated with intraneural needle placement without injection

Fredrickson

2009

Can J Anesth/J Can Anesth

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Purpose Recent reports of painless intraneural injection of low volumes of local anesthetic without subsequent neurological deficit have led to the suggestion that deliberate subepineural injection may be a safe and therefore acceptable practice. Clinical features This report describes a case where a venous cannulation needle inadvertently penetrated a patient's median nerve. Sudden onset severe lancinating pain occurred in the median nerve sensory distribution. A subsequent thorough ultrasound examination showed the median nerve to be located immediately posterior to the targeted median cubital vein. New onset sensory symptoms (numbness, tingling, pain, and altered sensation to touch) in the distribution of the penetrated median nerve persisted for [6 weeks. Conclusion This report highlights the hazards of intraneural needle placement irrespective of an associated injection. RésuméObjectif Des comptes-rendus re´cents rapportant une injection intraneurale indolore de faibles volumes d'anesthe´sique local sans de´ficit neurologique subse´quent nous ont mene´a`l'hypothe`se qu'une injection sous l'e´pine`vre pourrait constituer une pratique se´curitaire, donc acceptable. É léments cliniques Ce compte-rendu de´crit la situation suivante : une aiguille de canulation veineuse a pe´ne´treṕ ar inadvertance le nerf me´dian d'un patient. Une douleur lancinante se´ve`re et soudaine est apparue dans la distribution sensorielle du nerf me´dian. Par la suite, nous avons re´alise´un examen approfondi par ultrason qui a re´ve´le´que le nerf me´dian se situait imme´diatement derrie`re la veine cubitale me´diane vise´e. De nouveaux symptômes sensoriels (engourdissement, picotement, douleur, et sensation alte´re´e au toucher) ont persiste´dans la distribution du nerf me´dian pe´ne´tre´durant [ 6 semaines. Conclusion Ce compte-rendu de´montre les risques d'un placement intraneural d'aiguille inde´pendamment d'une injection associe´e.

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Intraneural injection during nerve stimulator-guided sciatic nerve block at the popliteal fossa

Abstract: Intraneural (subepineural) injection is a common occurrence after nerve stimulator-guided SN block at the popliteal fossa, yet it may not inevitably lead to neurological complications.

Cited by 103 publications

References 15 publications

Incidence of unintentional intraneural injection and postoperative neurological complications with ultrasound‐guided interscalene and supraclavicular nerve blocks*

Incidence of unintentional intraneural injection and postoperative neurological complications with ultrasound‐guided interscalene and supraclavicular nerve blocks*

Femoral Nerve Injury Following a Lumbar Plexus Blockade

Case report: Neurological deficit associated with intraneural needle placement without injection

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