High Opening Injection Pressure Is Associated With Needle-Nerve and Needle-Fascia Contact During Femoral Nerve Block

Gadsden, Jeff; Latmore, Malikah; Levine, Daniel M.; Robinson, Allegra

doi:10.1097/aap.0000000000000346

Cited by 39 publications

(31 citation statements)

References 24 publications

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“…Because of differences in neural architecture, 19 the current clinical adoption of the 15-psi cutoff as "abnormally high" appears to be based on an empirical summary of the available studies in which intraneural injections or needle-nerve contact are consistently associated with OIP of 15 psi or greater. 9,19,22,23 Because we used the same system as did Gadsden et al 23 (with calibration before every measurement), our results may have also been due to differences in viscoelasticity in these nerves. An arbitrary pressure cutoff is rather nonspecific or may be detected too late in the cycle of the injection to prevent intraneural injection.…”

Section: Discussionmentioning

confidence: 96%

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

Vermeylen

Hermans

Soetens

et al. 2017

Regional Anesthesia and Pain Medicine

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Section: Discussionmentioning

confidence: 96%

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

Vermeylen

Hermans

Soetens

et al. 2017

Regional Anesthesia and Pain Medicine

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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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“…Recently, Gadsden et al. have shown that injection pressures > 15 psi (103.4 kPa) may indicate needle‐nerve or needle‐fascia contact during interscalene and femoral nerve blocks .…”

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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High Opening Injection Pressure Is Associated With Needle-Nerve and Needle-Fascia Contact During Femoral Nerve Block

Abstract: Opening injection pressure greater than 15 psi was associated with a block needle tip position slightly indenting the epineurium of the femoral nerve (90%) and the fascia iliaca (100%). Needle tip positions not indenting these structures were associated with OIP of less than 15 psi (100%).

Cited by 39 publications

References 24 publications

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

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

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

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

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