Opening Injection Pressure Is Higher in Intraneural Compared With Perineural Injections During Simulated Nerve Blocks of the Lower Limb in Fresh Human Cadavers

Vermeylen, Kris; Hermans, Marlies; Soetens, Filiep; Vereecke, Evie; Steinfeldt, Thorsten; Groen, Gerbrand J.; Hadžić, Admir; Velde, Marc Van de

doi:10.1097/aap.0000000000000548

Cited by 26 publications

(24 citation statements)

References 26 publications

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“…Vermeylen et al. have recently demonstrated this phenomenon during simulated nerve blocks of the lower limb in fresh human cadavers . They redefined the opening injection pressure as the peak pressure in the 60‐s interval during which the injection is initiated.…”

Section: Discussionmentioning

confidence: 99%

“…The only way to have a reliable and reproducible measurement of tip pressure that is unaffected by injection parameters, is by measurement at the needle tip itself. In addition, tip pressure measurement is also able to precisely detect microscopic differences in tissue compliance and can monitor real and objective pressure injection profiles, such as the slope at the beginning of the injection, that could provide important information about tip position .…”

Section: Discussionmentioning

confidence: 99%

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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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Section: Discussionmentioning

confidence: 99%

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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“…In regional anaesthesia, measurement of injection pressure may be an effective adjuvant to ultrasound guidance in order to help detect unintended intraneural placement of the needle tip, thereby avoiding accidental intraneural injection. Different studies have described the application of injection pressure monitoring in peripheral nerve blockade aiming to detect intraneural needle tip positioning at an early stage via a sudden pressure rise, thus lowering the risk of consequent nerve injuries . The use of an injection pressure‐based risk profile has been suggested, to correlate peak injection pressure to the risk of nerve damage .…”

Section: Discussionmentioning

confidence: 99%

The effect of rate of injection on injection pressure profiles measured using in‐line and needle‐tip sensors: an in‐vitro study

et al. 2018

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Alongside ultrasonic visualisation, measurement of injection pressure is an effective tool for reducing the risk of intraneural injection during peripheral nerve block. The aim of this study was to compare injection pressure profiles when measured along the injection line with the pressure measured directly at the needle tip using different rates of injection. A syringe pump delivered a 5-ml injection of saline into silicone gel at three different speeds (5 ml.min , 10 ml.min and 15 ml.min ). Fibreoptic pressure sensors recorded real-time pressure profiles of the injection pressure directly at the needle tip and along the injection line. A total of 15 injections were successfully performed, five for each injection rate, totalling 30 recorded pressure profiles. More rapid rates of injection caused peak pressure measured in-line to increase, whereas pressure measured at the needle tip remained constant (mean (SD) pressure in-line 30.76 (3.45) kPa vs. 72.25 (1.55) kPa and mean (SD) pressure at needle tip 19.92 (1.22) kPa vs. 20.93 (2.66) kPa at 5 ml.min and 15 ml.min , respectively). Injection pressure profiles showed that in-line pressure measurement failed to record precise real-time pressure changes occurring at the needle tip (mean (95%CI) pressure difference 10.8 (6.98-14.70) kPa vs. 51.2 (47.52-54.89) kPa for in-line and needle-tip measures, respectively). We conclude that, in order to accurately monitor the true injection pressure generated, independent from operator and injection parameters, measurement at the needle tip is necessary, as injection pressure measured along the injection line is an unreliable surrogate.

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“…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 . However, all previous studies in animal models , cadavers or human subjects have measured pressure along the injection line. 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.…”

Section: Discussionmentioning

confidence: 99%

“…Although a rare complication, permanent nerve damage remains a major concern when performing peripheral nerve blocks . Injection pressure monitoring could be useful in detecting and/or preventing intraneural injections during peripheral nerve blocks in the clinical setting . Measurement and, consequently, limitation of injection pressure during a nerve block procedure may be of value in reducing the risk of nerve damage .…”

Section: Introductionmentioning

confidence: 99%

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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Opening Injection Pressure Is Higher in Intraneural Compared With Perineural Injections During Simulated Nerve Blocks of the Lower Limb in Fresh Human Cadavers

Abstract: In our fresh human cadaver model, OIP detected intraneural needle placement. Monitoring of OIP could be useful in detecting and/or preventing intraneural injection during nerve blocks in the clinical setting.

Cited by 26 publications

References 26 publications

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

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

The effect of rate of injection on injection pressure profiles measured using in‐line and needle‐tip sensors: an in‐vitro study

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

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