Opening Injection Pressure Consistently Detects Needle–Nerve Contact during Ultrasound-guided Interscalene Brachial Plexus Block

Gadsden, Jeff; Choi, Jinhyeok; Lin, Emily; Robinson, Allegra

doi:10.1097/aln.0000000000000133

Cited by 87 publications

(77 citation statements)

References 23 publications

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“…Injection pressure monitoring (w [15) has been studied in cadaver models, comparing when the needle is intraneural [9] and when the needle lies close to the nerve root but does not puncture it [16]. These studies demonstrated that nerve block pressure injection monitoring is a useful tool in order to prevent an intrafascicular injection in noncompliant neural structures like the brachial plexus.…”

Section: Commentmentioning

confidence: 99%

Permanent upper trunk plexopathy after interscalene brachial plexus block

Avellanet¹,

Sala‐Blanch

Rodrigo³

et al. 2015

J Clin Monit Comput

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Interscalene brachial plexus block (IBPB) has been widely used in shoulder surgical procedures. The incidence of postoperative neural injury has been estimated to be as high as 3 %. We report a long-term neurologic deficit after a nerve stimulator assisted brachial plexus block. A 55 year-old male, with right shoulder impingement syndrome was scheduled for elective surgery. The patient was given an oral dose of 10 mg of diazepam prior to the nerve stimulator assisted brachial plexus block. The patient immediately complained, as soon as the needle was placed in the interscalene area, of a sharp pain in his right arm and he was sedated further. Twenty-four hours later, the patient complained of severe shoulder and arm pain that required an increased dose of analgesics. Severe peri-scapular atrophy developed over the following days. Electromyography studies revealed an upper trunk plexus injury with severe denervation of the supraspinatus, infraspinatus and deltoid muscles together with a moderate denervation of the biceps brachii muscle. Chest X-rays showed a diaphragmatic palsy which was not present post operatively. Pulmonary function tests were also affected. Phrenic nerve paralysis was still present 18 months after the block as was dysfunction of the brachial plexus resulting in an inability to perform flexion, abduction and external rotation of the right shoulder. Severe brachial plexopathy was probably due to a local anesthetic having been administrated through the perineurium and into the nerve fascicles. Severe brachial plexopathy is an uncommon but catastrophic complication of IBPB. We propose a clinical algorithm using ultrasound guidance during nerve blocks as a safer technique of regional anesthesia.

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Section: Commentmentioning

confidence: 99%

Permanent upper trunk plexopathy after interscalene brachial plexus block

Avellanet¹,

Sala‐Blanch

Rodrigo³

et al. 2015

J Clin Monit Comput

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“…One recent study has suggested that high opening injection pressures (100 kPa) detected using the BSmart may indicate needle-tonerve contact, and that avoiding injection when pressures are high may help to prevent intraneural injection and nerve injury [8].…”

Section: Nerve Block Injection Pressure Monitoringmentioning

confidence: 99%

Nerve block injection pressure monitoring

Adams

2015

Anaesthesia

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“…In more than 80% they noted an intraneural needle insertion. Gadsden and his group measured minimal threshold currents during pre-contact and needle-nerve contact positions, as validated by ultrasound, at the interscalene plexus in 15 patients 15 . They noted a current intensity of 0.2-0.3 mA during the needle-nerve contact and currents between 0.5 and 0.7 mA in the pre-contact positions.…”

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confidence: 99%