Peripheral Nerve Injury After Local Anesthetic Injection

Faber, Scott J.; Saheb-Al-Zamani, Maryam; Zieske, Lawrence; Laurido-Soto, Osvaldo; Bery, Amit; Hunter, Daniel A.; Johnson, Philip J.; Mackinnon, Susan E.

doi:10.1097/01.sa.0000435470.83115.23

Cited by 12 publications

(16 citation statements)

References 2 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…More recently, Farber et al . () observed no injury at the ultrastructural level (apart from the occasional injury caused by the needle) in the saline group of rats of a study demonstrating injury after local anaesthetic injections. However, severe damage was found after infiltrating the same volumes of anaesthetics.…”

Section: Discussionmentioning

confidence: 93%

Ultrasound-guided plasma rich in growth factors injections and scaffolds hasten motor nerve functional recovery in an ovine model of nerve crush injury

Sánchez

Anitua²,

Delgado

et al. 2015

J Tissue Eng Regen Med

View full text Add to dashboard Cite

In the present study we evaluated the motor recovery process of peripheral nerve injury (PNI), based on electrophysiological and histomorphometric criteria, after treatment with plasma rich in growth factors (PRGF) injections and scaffolds in an ovine model. Three groups of sheep underwent a nerve crush lesion: the first group (n = 3) was left to recover spontaneously (SR); the second group was administered saline injections (SI; n = 5) and a third group (n = 6) received PRGF injections and scaffolds immediately after the crush injury. At post-intervention week 8, 70% of sheep in the PRGF group were CMAP-positive, with no electrophysiological response in the rest of the groups. Histomorphometric analysis 12 weeks after the surgical intervention revealed that the average axonal density of the SR (1184 ± 864 axons/µm ) and SI (3109 ± 2450 axons/µm ) groups was significantly inferior to the control (8427 ± 2433 axons/µm ) and also inferior to the PRGF group (5276 ± 4148 axons/µm ), showing no significant differences between the control and PRGF groups. The axonal size of the SR and SI groups was significantly smaller compared with the control group (18 ± 4 µm ), whereas the axonal size of the PRGF group (6 ± 5 µm ) did not show statistical differences from the control. Morphometry of the target muscles indicated that the PRGF group had the lowest percentage volume reduction 12 weeks after the crush injury. The PRGF group had larger muscle fibre areas than the SI and SR groups, although the differences did not reach statistical significance. Overall, these data suggest that the PRGF injections and scaffolds hastened functional axon recovery and dampened atrophy of the target muscles in an ovine model. Copyright © 2015 John Wiley & Sons, Ltd.

show abstract

Section: Discussionmentioning

confidence: 93%

Ultrasound-guided plasma rich in growth factors injections and scaffolds hasten motor nerve functional recovery in an ovine model of nerve crush injury

Sánchez

Anitua²,

Delgado

et al. 2015

J Tissue Eng Regen Med

View full text Add to dashboard Cite

show abstract

“…Even without neuronal compression by intraneural injection, disruption of the protective perineurium covering the fascicle by intrafascicular injection may expose axons to inflammatory processes, local anaesthetic‐induced toxicity and harmful direct mechanical damage. There can be no doubt that intraneural injection should be avoided .…”

Section: Peripheral Nerve Injury Related To Peripheral Nerve Blockadementioning

confidence: 99%

Peripheral nerve injury arising in anaesthesia practice

2018

View full text Add to dashboard Cite

SummaryIn this article, we will discuss the pathophysiology of peripheral nerve injury in anaesthetic practice, including factors which increase the susceptibility of nerves to damage. We will describe a practical and evidence-based approach to the management of suspected peripheral nerve injury and will go on to discuss major nerve injury patterns relating to intra-operative positioning and to peripheral nerve blockade. We will review the evidence surrounding particular strategies to reduce the incidence of peripheral nerve injury during nerve blockade, including nerve localisation methods, timing of blocks, needle techniques and design, injection pressure-monitoring and local anaesthetic and adjunct choice. Pathophysiology of peripheral nerve injuryPeripheral nerve injury during the peri-operative period can occur when a nerve is subjected to stretch, compression, hypoperfusion, direct trauma, exposure to neurotoxic material or a combination of these factors [1,2].In many cases, no clear aetiology for nerve injury is apparent [3,4]. The shared pathophysiological precipitant of these injuries is often nerve hypoperfusion and consequent ischaemia due to physical disruption of the vasa nervorum, intraneural haemorrhage and/or endoneural oedema [5]. These result in a spectrum of histological neural abnormalities ranging from impaired axoplasmic transport, axonal degeneration, Schwann cell damage, myelin destruction, segmental demyelination and complete Wallerian degeneration [6][7][8]. Depending on the severity and duration of the ischaemic insult, either temporary or permanent disruption to nerve impulse transmission can result. There is a loose relationship between the severity of the original pathophysiological mechanism, degree of nerve ischaemia and subsequent clinical presentation, although in an animal model of compression injury, the degree of histological nerve damage has been correlated with the degree and duration of compression [8].Established peripheral neuropathy, pre-existing (but subclinical) peripheral neuropathy, profound hypothermia, hypovolaemia, hypotension, hypoxaemia, electrolyte disorders, malnutrition, small or large body mass index (BMI), tobacco use and anatomical variants (such as the presence of cervical ribs) may increase the susceptibility of peripheral nerves to peri-

show abstract

“…There is little ambiguity that intraneural, in particular intrafascicular, injection exposes axons to both mechanical injury and the cytotoxic effects of local anaesthetics. Intrafascicular injection results in severe histological abnormalities and functional deficits and should be avoided . The exact site of injection is critical, intrafascicular local anaesthetics cause marked histological abnormalities , whereas extrafascicular and extraneural (external to the epineurium) injections cause milder histological abnormalities.…”

Section: Why Monitor Pressure?mentioning

confidence: 99%