A simple low-cost way of measuring injection pressure during peripheral nerve block

Siegmueller, Claas; Ramessur, Suneil

doi:10.1111/j.1365-2044.2011.06849.x

Cited by 11 publications

(6 citation statements)

References 4 publications

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“…118,119 In the meantime, several means of monitoring injection pressures have been recommended. 116,120 Taken together, the data to date suggest that high opening injection pressure can detect needle-nerve contact and intrafascicular injection but not an intraneural interfascicular injection. 109,111 In the first study in patients, Gadsden and colleagues 121 demonstrated that opening injection pressure with the needle tip at 1 mm away from the nerve was consistently lower than 15 psi (mean peak pressure, 8.2 ± 2.4 psi).…”

Section: Injection Pressure Monitoringmentioning

confidence: 95%

“…115,116 This is not surprising, given that injection into densely packed nerve fascicles requires more force to initiate an injection (opening pressure) than intraneural interfascicular injections into the loose connective tissue. In an attempt to standardize monitoring and documentation of nerve block procedures, a group of North American experts has suggested documenting the resistance to injection as one of the elements of the standard clinical note.…”

Section: Injection Pressure Monitoringmentioning

confidence: 99%

See 1 more Smart Citation

Pathophysiology and Etiology of Nerve Injury Following Peripheral Nerve Blockade

Brull

Hadžić

Reina

et al. 2015

Regional Anesthesia and Pain Medicine

183

106

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Section: Injection Pressure Monitoringmentioning

confidence: 95%

Section: Injection Pressure Monitoringmentioning

confidence: 99%

Pathophysiology and Etiology of Nerve Injury Following Peripheral Nerve Blockade

Brull

Hadžić

Reina

et al. 2015

Regional Anesthesia and Pain Medicine

183

106

View full text Add to dashboard Cite

show abstract

“…Other investigators described procedures that exploit pressure monitors in syringe pumps [25]. We suggest the procedures described are more complex and systems more cumbersome than our IPG.…”

Section: Comparison With Existing Devicesmentioning

confidence: 94%

“…However, commercially available regional anesthesia pressure monitors are limited in their adoption because of their costs-for example, the BSmart TM pressure manometer made by Concert Medical, USA has a unit cost of US$10.44 [25]. Other clinical pressure monitors such as invasive pressure transducers also incur costs and more importantly, are not designed for the relatively high pressures encountered in regional anesthesia injections.…”

Section: Comparison With Existing Devicesmentioning

confidence: 99%

An improvised pressure gauge for regional nerve blockade/anesthesia injections: an initial study

Patil

Ankireddy

Wilkes³

et al. 2015

J Clin Monit Comput

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High injection pressure is one of the warning signs of intraneural injection, with animal models suggesting pressures higher than 69 or 176 kPa as high risk, and is normally detected subjectively and inaccurately. We describe a system improvised from common clinical components that uses Boyle's law to objectively measure injection pressure. The objectives of the study were to (1) Validate our improvised pressure gauge (IPG) by comparing the injection pressure as calculated by Boyle's law against the measured pressure and (2) Use the IPG to measure the range of injection pressures by two groups of anesthetic professionals using the "syringe feel" technique. Our IPG system consists of an extended 1 ml syringe attached to a 3-way stopcock, inserted between the syringe containing the local anesthetic injectate and the needle. The IPG was validated against a pressure calibration reference. 20 anesthesiologists and 20 anesthetic assistants were recruited to apply pressure to the 20 ml syringe in vitro while blinded to the attached IPG. The pressures were measured on three separate occasions for each participant. There was good agreement (<8 percent difference) between the measured and theoretical pressure values. Anesthesiologists exceeded the threshold of 69 kPa in 18 of a total of 60 attempts whereas anesthetic assistants exceeded the threshold in 30 attempts out of 60 attempts. Anesthetic assistants exerted a higher overall pressure of 80 kPa compared to 51 kPa for anesthesiologists-this was statistically significant (p = 0.027). Our improvised system is easily and rapidly assembled from common clinical equipment and shows promise as a monitor for inadvertent intraneural injection.

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“…One such method, the compressed air injection technique, uses Boyle’s Law to maintain injection pressure below the threshold considered clinically significant for nerve injury 8. Others have suggested the use of arterial or central line pressure transducers for real-time measurement of injection pressure 9. Tactile feel of syringe pressure by experienced regionalists was also explored and found to be inconsistent, and is affected by needle dimensions and syringe size 10 11…”

mentioning

confidence: 99%

Evaluation of the B-Smart manometer and the CompuFlo computerized injection pump technology for accurate needle-tip injection pressure measurement during peripheral nerve blockade

Weisman

Bhavsar

Schuster

et al. 2019

Regional Anesthesia &Amp; Pain Medicine

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Background and ObjectivesThe exact mechanism of peripheral nerve blocks causing/leading to nerve injury remains controversial. Evidence from animal experiments suggests that intrafascicular injection resulting in high injection pressure has the potential to rupture nerve fascicles and may consequently cause permanent nerve injury and neurological deficits. The B-Smart (BS) in-line manometer and the CompuFlo (CF) computerized injection pump technology are two modalities used for monitoring pressure during regional anesthesia. This study sought to explore the accuracy of these two technologies in measuring needle-tip pressures in a simulated environment.MethodsIn seven simulated needle–syringe combinations, the BS and the CF devices were connected in series through a closed system and attached to a digital manometer at the tip of various needles. The pressures were evaluated in three trials per needle-syringe combination. Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy (F1 Score) were determined for each needle type and overall.ResultsFor pressures ≥15 psi and ≥20 psi, respectively, the CF device demonstrated a sensitivity of 100%, 100%; specificity of 96%, 98%; positive predictive value 93%, 93%; and negative predictive value of 100%, 100%. The BS device demonstrated a sensitivity of 60%, 100%; specificity of 99%, 95%; positive predictive value of 96%, 85%; and negative predictive value of 85%, 100%. Accuracy, as measured by the F1 Score, for detecting a pressure of ≥15 psi was 0.96 for the CF and 0.74 for the BS.ConclusionsFuture research is needed to explore in-vivo performance and evaluate whether either of these devices can impact on clinical outcomes.

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A simple low-cost way of measuring injection pressure during peripheral nerve block

Cited by 11 publications

References 4 publications

Pathophysiology and Etiology of Nerve Injury Following Peripheral Nerve Blockade

Pathophysiology and Etiology of Nerve Injury Following Peripheral Nerve Blockade

An improvised pressure gauge for regional nerve blockade/anesthesia injections: an initial study

Evaluation of the B-Smart manometer and the CompuFlo computerized injection pump technology for accurate needle-tip injection pressure measurement during peripheral nerve blockade

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