Inflammatory Response After Injection of Aqueous Gel Into Subarachnoid Space in Piglets

Pintarič, Tatjana Stopar; Hadžić, Admir; Štrbenc, Malan; Podpečan, Ožbalt; Podbregar, Matej; Cvetko, Erika

doi:10.1097/aap.0b013e318284176a

Cited by 21 publications

(7 citation statements)

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“…This is consistent with a previous study of ultrasound gel [14]. Pintaric and coworkers found that intrathecal injection of ultrasound gel in piglets increased protein levels in cerebrospinal fluid and caused infiltration of inflammatory cells into the meninges and spinal cord [15]. An inflammatory response occurs after perineural injection of ultrasound gel but there is no evidence that this is clinically significant.…”

Section: Discussionsupporting

confidence: 90%

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Absence of neurotoxicity with perineural injection of ultrasound gels: assessment using an animal model

et al. 2013

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BackgroundUltrasound gels may contain propylene glycol and glycerol, which are neurotoxic in high concentrations. If the needle passes through gel during regional anesthesia, gel may be injected near the nerve. It is unknown if this practice poses a risk for neurotoxicity. Using an animal model, we assessed the histological changes of perineural propylene glycol on nerves. We then assessed three commonly used sterile gels for evidence of neurotoxicity.MethodsMicro-ultrasound guided perineural sciatic nerve injections were performed in mice. Propylene glycol (PG) 2.5%, 10%, 35%, 70% (v/v) or saline was injected. Nerves were assessed after three days for evidence of neurotoxicity. Aquasonic® 100 Ultrasound Gel, K-Y® Lubricating Jelly, and PDI® Lubricating Jelly were also studied against saline controls.ResultsConfluent areas of axonal degeneration and intraneural inflammation occurred in 5 of 9 specimens injected with 70% PG. At 35%, 2 of 8 specimens showed patchy changes not present at lower concentrations. No degeneration occurred with Aquasonic® 100 or PDI® Lubricating Jelly. In the K-Y® group, one gel and one saline specimen demonstrated confluent degenerative changes.ConclusionsSimilar to glycerol, 70% PG may cause confluent areas of axon and myelin degeneration with associated intraneural inflammation. The concentration of PG present in ultrasound gels is unlikely to cause neurotoxicity. Aquasonic® 100 and PDI® Lubricating Jelly did not cause neurotoxicity. The results for K-Y® Lubricating Jelly are inconclusive. There is no evidence that passing the needle through the studied gels during regional anesthesia procedures is harmful.

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Section: Discussionsupporting

confidence: 90%

“…One ultrasound gel (Pharmaceutical Innovations, Newark, NJ) has been studied in a porcine peripheral nerve model and demonstrated no histological evidence of neurotoxicity [14]. Another study found that Eko gel (Eurocamina S.r.l., Salerno, Italy) injected intrathecally causes meningeal and spinal inflammation [15]. …”

Section: Introductionmentioning

confidence: 99%

Absence of neurotoxicity with perineural injection of ultrasound gels: assessment using an animal model

et al. 2013

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“…During surgical exploration, adhesions, fascial thickening, vascular changes, and scar tissue (present in 10 of 14 patients) involving the phrenic nerve suggested chronic inflammation and were consistent with a compression neuropathy. Animal data suggest that ultrasound gel can lead to inflammation in the subarachnoidal space 47 and peripheral nerves. 48 …”

Section: Inflammatory Injurymentioning

confidence: 99%

Pathophysiology and Etiology of Nerve Injury Following Peripheral Nerve Blockade

Brull

Hadžić

Reina

et al. 2015

Regional Anesthesia and Pain Medicine

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“…To optimize sonographic images, adjustment of depth (usually 7–10 cm), focus positioning, and gain settings on the US machine are essential. During US-guided neuraxial block, it is crucial to remove gel or chlorhexidine from the skin before needle insertion to avoid potential neurologic complications, including adhesive arachnoiditis [ 2 , 3 ].…”

Section: Us-guided Techniques For Lumbar Neuraxial Blockmentioning

confidence: 99%

Ultrasonography for lumbar neuraxial block

et al. 2020

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Ultrasonography can be useful to perform a lumbar neuraxial block. It aids in understanding the anatomy of the lumbar spine before the procedure. Pre-procedural ultrasound imaging provides information about the accurate intervertebral level for puncture, optimal needle insertion point, and depth of needle advancement for a successful neuraxial block. The key ultrasonographic views for lumbar neuraxial block include the transverse midline interlaminar and parasagittal oblique views. Ultrasonography can facilitate lumbar neuraxial block in difficult cases, such as the elderly, obese patients, and patients with anatomical abnormality of the lumbar spine. This review elucidates the basics of spinal ultrasonography for lumbar neuraxial block and the current evidence regarding ultrasound-guided neuraxial block in adults.

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Inflammatory Response After Injection of Aqueous Gel Into Subarachnoid Space in Piglets

Abstract: Subarachnoid injection of ultrasound gel in piglets results in an inflammatory response within neuraxial space.

Cited by 21 publications

References 18 publications

Absence of neurotoxicity with perineural injection of ultrasound gels: assessment using an animal model

Absence of neurotoxicity with perineural injection of ultrasound gels: assessment using an animal model

Pathophysiology and Etiology of Nerve Injury Following Peripheral Nerve Blockade

Ultrasonography for lumbar neuraxial block

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