Brachial Plexus Root Injection in a Human Cadaver Model

Orebaugh, Steven L.; Mukalel, Jessen; Krediet, Annalot C.; Weimer, Jonathan M.; Filip, Patrick; McFadden, Kathryn; Bigeleisen, Paul E.

doi:10.1097/aap.0b013e3182660be2

Cited by 37 publications

(4 citation statements)

References 13 publications

(12 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The present investigation confirms previously identified positive correlations between increased injection pressures and intraneural placement ( 13 , 18 , 20 ). Orebaugh et al ( 17 ) conducted a study in which unembalmed cadaveric nerve roots were injected intraneurally at the C6 and C7 level and the pressure of injection as well as the spread of the injected materials was recorded. Their results’ were in concordance with our findings and showed that intraneural needle placement produces an elevated injection pressure with a mean time to peak injection pressure of 10.3 ± 3.3 seconds.…”

Section: Discussionmentioning

confidence: 99%

“…A probable explanation for the difference in magnitude of the opening injection pressures is that the greater values were achieved in their study though the use of a greater injection rate and volume of fluid. Orebaugh et al ( 17 ) used 5 mL of fluid with a rate of 5 mL per 15 seconds (0.33 mL/sec) in comparison to 1 mL of NaCl with a rate of 0.1 mL/sec in our study. Introducing larger volume with faster rate into an enclosed space, such as the cervical nerve roots, might explain the greater increase in pressure.…”

Section: Discussionmentioning

confidence: 99%

“…There is currently very limited human or cadaveric data regarding intraneural injection pressure ( 4 ). We are aware of a single study ( 17 ) on human cadavers where the brachial plexus roots in unembalmed human cadavers were injected and the pressure injection as well as the spread of the injected materials were recorded. The intraneural injection pressure was very high, with a mean of 48.9 psi, in comparison two control injections with needle inserted adjacent to the epineurium of C6 and C7 nerve root with pressure of 17.6 and 8.2 psi for 5 and 15 mL injected volume, respectively; however, this finding was not a primary focus of the investigation.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Pressure Monitoring of Intraneural an Perineural Injections Into the Median, Radial, and Ulnar Nerves; Lessons From a Cadaveric Study

et al. 2015

View full text Add to dashboard Cite

Background:Nerve damage after regional anesthesia has been of great concern to anesthetists. Various modalities have been suggested to recognize and prevent its incidence. An understudied area is the measurement of intraneural pressure during peripheral nerve blockade. Previous investigations have produced contradicting results with only one study being conducted on human cadavers.Objectives:The purpose of this investigation was to systematically record intraneural and perineural injection pressures on the median, ulnar, and radial nerves exclusively as a primary outcome.Materials and Methods:Ultrasonography-guided injections of 1 mL of 0.9% NaCl over ten seconds were performed on phenol glycerine embalmed cadaveric median, ulnar, and radial nerves. A total of 60 injections were performed, 30 intraneural and 30 perineural injections. The injections pressure was measured using a controlled disc stimulation device. Anatomic dissection was used to confirm needle placement.Results:Intraneural needle placement produced significantly greater pressures than perineural injections did. The mean generated pressures in median, radial, and ulnar nerves were respectively 29.4 ± 9.3, 27.3 ± 8.5, and 17.9 ± 7.0 pound per square inch (psi) (1 psi = 51.7 mmHg) for the intraneural injections and respectively 7.2 ± 2.5, 8.3 ± 2.5, and 6.7 ± 1.8 psi for perineural injections. Additionally the intraneural injection pressures of the ulnar nerve were lower than those of the median and radial nerves.Conclusions:Obtained results demonstrate significant differences between intraneural and perineural injection pressures in the median, ulnar, and radial nerves. Intraneural injection pressures show low specificity but high sensitivity suggesting that pressure monitoring might be a valuable tool in improving the safety and efficacy of peripheral nerve blockade in regional anesthesia. Peripheral nerves “pressure mapping” hypothetically might show difference amongst various nerves depending on anatomic location, histologic structure, and ultrasonographic appearance.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Pressure Monitoring of Intraneural an Perineural Injections Into the Median, Radial, and Ulnar Nerves; Lessons From a Cadaveric Study

et al. 2015

View full text Add to dashboard Cite

show abstract

“…This cut-off point (15 psi) was further supported by a fresh human cadaver model, where opening injection pressure for intraneural injection was ranging from 21.5 ± 4.9 psi to 25.8 ± 4.3 psi for common ultrasound-guided lower extremity blocks [ 17 ]. A volume of 5 mL injection into the brachial plexus root within 15 sec results in a much higher opening injection pressure (>30 psi) in 100% fresh cadavers [ 18 ]. A human study demonstrated cessation of injection when opening pressure more than 20 psi for popliteal sciatic block does not result in neurological dysfunction [ 19 ].…”

mentioning

confidence: 99%