Nerve block injection pressure monitoring

Adams, Alex

doi:10.1111/anae.13357

Cited by 8 publications

(9 citation statements)

References 7 publications

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“…An exact measurement of injection pressure at the needle tip is essential in order to understand the flow dynamics at the injection site . Measurement of injection pressure is considered to be a pivotal element in the detection of intraneural placement of a peripheral nerve block needle in order to reduce the risk of nerve damage .…”

Section: Discussionmentioning

confidence: 99%

“…These measurements are affected by speed of injection and the dimensions of the needle and connection tubing , which make their usefulness in clinical practice uncertain. Thus, there is a need to develop a novel injection pressure monitoring system that is capable of being used during the performance of peripheral nerve blocks .…”

Section: Discussionmentioning

confidence: 99%

“…This suggests that injection pressure at the needle tip varies according to nerve micro‐anatomy and physical characteristics of the tissue. The subjective sensation of a high injection pressure does not reliably detect intraneural injection and the development of a validated, objective injection pressure monitoring system is needed .…”

Section: Introductionmentioning

confidence: 99%

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The ability of a real‐time injection pressure monitoring system to discriminate between perineural and intraneural injection of the sciatic nerve in fresh cadavers

2018

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Injection pressure monitoring provides valuable information to prevent intraneural injections and possibly consequent nerve damage during peripheral nerve block. However, the measurement of injection pressure along the injection line is inaccurate as it is influenced by several variables. The aim of this study was to test a new system for precise injection pressure monitoring at the needle tip in a cadaveric model. The system consists of a miniaturised pressure sensor embedded within the needle shaft that is connected via an optical fibre to an external control unit. In order to test the capacity of the system to discriminate between perineural and intraneural injections, a total of 24 ultrasound-guided injections at various locations of the sciatic nerve (12 perineural and 12 intraneural) were performed in fresh cadavers. The injections were delivered at a constant rate by an electronic pump (5 ml saline at 10 ml.min ). Two perineural and two intraneural injections were excluded from analysis, since the operator could not confirm the exact needle-tip location. Mean (SD) peak injection pressure was significantly lower for perineural compared with intraneural injections (14 (6) kPa vs. 131 (56) kPa; p < 0.001). This study shows that this system is a reliable method to accurately monitor injection pressure at the needle tip, allowing for discrimination between perineural and intraneural injections of the sciatic nerve in fresh cadavers.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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The ability of a real‐time injection pressure monitoring system to discriminate between perineural and intraneural injection of the sciatic nerve in fresh cadavers

2018

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“…The injection pressure detected by a sensor placed remotely to the needle tip, along the injection line, is influenced by the injection system and its parameters; namely the speed of injection, the size of the needle and the size of the connection tubes. Any injection pressure monitor in the injection line would therefore need to be calibrated and validated for that specific injection system .…”

Section: Discussionmentioning

confidence: 99%

Real‐time continuous monitoring of injection pressure at the needle tip for peripheral nerve blocks: description of a new method

2017

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The measurement of injection pressure during the performance of peripheral nerve blocks can be pivotal to detect intraneural placement of the needle tip and thus avoid intrafascicular injection. However, injection pressure can only be measured along the injection line (tubing), which is influenced by several factors. The primary aim of this feasibility study was to describe and validate the principle of a novel nerve-block needle conceived for real-time continuous monitoring of injection pressures at the needle tip. Our secondary aim was to provide measurements and compare injection pressure values at the needle tip and in the injection line. Four porcine lower limb anatomic models were prepared and extraneural injections were performed with fractioned boluses of 2 ml saline at a controlled infusion rate of 10 ml.min (0.16 ml.s ). Injection pressure at the needle tip was monitored and compared with the pressure in the injection line. The system proved to be reliable. Thirty injections were successfully performed without technical failures. The mean (95%CI) difference between pressures at the needle tip and the injection line varied substantially from 14.33 (12.58-16.08) kPa at 0.5 ml injected volume to 41.56 (39.66-43.45) kPa at the end of the injection. This study demonstrates that the described system allows for real-time continuous monitoring of injection pressure at the needle tip. Moreover, this study shows that injection pressure values measured in the injection line cannot be assumed to be a reliable indicator of the injection pressure at the needle tip.

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“…Hereby, we suggest to have a heightened suspicion of abnormal caudal space, and to anticipate difficulty with caudal placement in congenital adrenal hyperplasia patients, we also recommend ultrasound screening of the caudal space in such children whenever feasible and to avoid drug administration if undue resistance is encountered during drug injection .…”

mentioning

confidence: 99%

Unusually narrow caudal space with undue resistance to drug injection in a congenital adrenal hyperplasia child

Arumugam

Rai

Ancheri

et al. 2016

Pediatric Anesthesia

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Nerve block injection pressure monitoring

Cited by 8 publications

References 7 publications

The ability of a real‐time injection pressure monitoring system to discriminate between perineural and intraneural injection of the sciatic nerve in fresh cadavers

The ability of a real‐time injection pressure monitoring system to discriminate between perineural and intraneural injection of the sciatic nerve in fresh cadavers

Real‐time continuous monitoring of injection pressure at the needle tip for peripheral nerve blocks: description of a new method

Unusually narrow caudal space with undue resistance to drug injection in a congenital adrenal hyperplasia child

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