Opening injection pressure as a part of multimodal monitoring to detect intraneural injections

Costa, Fabio; Porcellini, Giuseppe; Buono, Romualdo Del; Strumia, Alessandro; Schiavoni, Lorenzo; Mattei, Alessia; Cataldo, Rita; Carassiti, Massimiliano

doi:10.1136/rapm-2021-103363

Reg Anesth Pain Med

2022

DOI: 10.1136/rapm-2021-103363

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Opening injection pressure as a part of multimodal monitoring to detect intraneural injections

Fabio Costa

Giuseppe Porcellini

Romualdo Del Buono

et al.

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Cited by 3 publications

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“…We would like to thank Costa et al 1 for their interest in our study 2. We fully agree, as previously outlined, that pressure monitoring plays an important role in the prevention of nerve injury, and our results should not discourage from progressing in this direction 3.…”

supporting

confidence: 86%

Response to Dr Costa

Mejia

Sala‐Blanch

2022

Reg Anesth Pain Med

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supporting

confidence: 86%

Response to Dr Costa

Mejia

Sala‐Blanch

2022

Reg Anesth Pain Med

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Identification of spread after deliberate intraneural injection in five mammalian species

Server,

Boezaart,

Perez-Carrasco

et al. 2023

Reg Anesth Pain Med

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IntroductionThis research endeavors to investigate the phenomenon of intraneural spread across distinct locations: subcircumneurium, extrafascicular intraneural, intrafascicular intraneural, and intraperineurium after deliberate intraneural injections across five mammalian species. The study also aims to propose determinants influencing this spread. Furthermore, the investigation strives to ascertain the optimal animal species and needle configuration for extrapolating intraneural injection outcomes to human contexts.MethodsThis study examined 60 sciatic nerves from 30 fresh and untreated cadavers of rats, rabbits, dogs, pigs, and sheep. The specimens were organized into five groups, each comprising an equal number of nerves. Histological assessments were performed on 30 nerves, involving fascicle metrics. The remaining 30 nerves underwent intentional intraneural injections, facilitated by 19G and 23G needles under ultrasound and direct visualization guidance.Heparinized erythrocytes combined with a methylene blue solution were used as a marker to analyze the extent and patterns of intraneural spread. Needle orifice measurements were obtained, and these data were overlaid onto images of both nerves and needles. This enabled a comparative evaluation of sizes and an assessment of marker diffusion.ResultsThe findings indicated that sciatic nerves in rats, rabbits, and dogs were oligofascicular, characterized by larger fascicles, whereas pigs and sheep exhibited polyfascicular nerves comprised of numerous smaller fascicles. Fascicular diameters were variable across species, with dogs presenting the largest measurements. While intraneural spread was observed and documented, intrafascicular marker spreading was rare, occurring only in one rabbit specimen. Needle orifice attributes were scrutinized and visually depicted.ConclusionsDespite the formidable challenges associated with the practical realization of intrafascicular injection, the utilization of animal models possessing monofascicular or oligofascicular nerves, such as rats, rabbits, and dogs, in conjunction with needles featuring aperture dimensions surpassing those of the fascicles, likely contributes to the compromised reliability of investigations into intraneural injection outcomes.

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An indwelling Teflon vascular catheter used for modified intercostal nerve neurolysis under combination of fluoroscopy and ultrasound guidance

KIMURA,

KOBAYASHI,

ANEZAKI

et al. 2024

Minerva Anestesiol

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Opening injection pressure as a part of multimodal monitoring to detect intraneural injections

Cited by 3 publications

References 6 publications

Response to Dr Costa

Response to Dr Costa

Identification of spread after deliberate intraneural injection in five mammalian species

An indwelling Teflon vascular catheter used for modified intercostal nerve neurolysis under combination of fluoroscopy and ultrasound guidance

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