Reducing the risk of neurological complications after peripheral nerve block: what is the role of pressure monitoring?

Barrington, Michael J.; Lirk, Philipp

doi:10.1111/anae.14469

Cited by 12 publications

(9 citation statements)

References 27 publications

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“…A systematic review of animal studies showed that the harmful effects of nerve block are mostly caused by mechanical damage, volumetric pressure and neurotoxicity ( Sondekoppam and Tsui, 2017 ; Hewson et al, 2018 ; Barrington and Lirk, 2019 ). In this study, the minimum effective volume for rat SGB under ultrasound guidance was 0.020 ml, while the minimum effective volume for rat SGB under blind detection was 0.639 ml.…”

Section: Discussionmentioning

confidence: 99%

Establishment of ultrasound-guided stellate ganglion block in rats

et al. 2023

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BackgroundA novel protocol for accurate stellate ganglion block under ultrasound guidance was designed in rats. This technique raises the success rate of stellate ganglion block and reduces the incidence of brachial plexus and vagus nerve block.MethodsFifty-six Sprague-Dawley were randomly divided into an ultrasound-guided group (n = 28) and a blind technique group (n = 28). The rats in the blind technique group were injected with 1.5% lidocaine mixed with methylene blue after signs of brachial plexus stimulation were elicited. The lateral side of the cephalic brachial vein was located under the first rib, where lidocaine was injected into the rats in the ultrasound-guided group. The up-and-down sequential method of Dixon was used to determine the minimum effective volume for stellate ganglion block in rats. Furthermore, we calculated the required operative duration of the two methods and observed the difference in the lidocaine diffusion range between the two groups.ResultsThe minimum effective volume for stellate ganglion block in the ultrasound-guided group was 0.040 ml, and the 95% CI was 0.026–0.052 ml. In the blind technique group, the minimum effective volume was 0.639 ml, and the 95% CI was 0.490–0.733 ml. Within the 95% CI of the lowest effective volume, the incidence of brachial plexus block as a complication of stellate ganglion block under ultrasound guidance was 10.00%.ConclusionStellate ganglion block under ultrasound guidance is more accurate than blind detection, which the incidence of complications of stellate ganglion block under ultrasound guidance was significantly lower than under blind detection; the rate of methylene blue staining in the vagus nerve was significantly lower under ultrasound guidance.

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Section: Discussionmentioning

confidence: 99%

Establishment of ultrasound-guided stellate ganglion block in rats

et al. 2023

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“…Research has demonstrated that a low OIP (<15psi) is associated with safe injections in non-neural tissue (32). However, due to the low incidence of post peripheral nerve block injury, robust in vivo human data confirming the effectiveness of pressure monitoring to prevent PNI is lacking (33). Furthermore, the debate regarding the ideal pressure monitoring system is ongoing.…”

Section: -Sedationmentioning

confidence: 99%

“…Unfortunately, in line pressure monitor devices do not reliably represent the pressure at the tip of the needle (35). Although, robust evidence is lacking, the working group considers pressure monitor devices valuable tools to increase safety for which further research is needed (33).…”

Section: -Sedationmentioning

confidence: 99%

Guidelines for the safe clinical practice of peripheral nerve blocks in the adult patient

Desmet¹,

Bindelle²,

Breebaart³

et al. 2020

Acta Anaest Belg

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“…Over the past years, ultrasound (US) and neurostimulation (NS) represented the “gold standard” of monitoring techniques for nerve blockade [ 8 ]. The concept of “opening injection pressure (OIP)” and its ability to detect a needle–nerve contact and intraneural injection has been recently introduced [ 9 , 10 , 11 , 12 ]. Opening injection pressure is defined as the pressure to be applied to the syringe piston that is necessary to win the resistance at the tip of the needle and make the flow start.…”

Section: Introductionmentioning

confidence: 99%

Triple Monitoring May Avoid Intraneural Injection during Interscalene Brachial Plexus Block for Arthroscopic Shoulder Surgery: A Prospective Preliminary Study

Porcellini

Strumia

Costa

et al. 2021

JCM

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Nerve injury is a feared complication of peripheral nerve blockade. The aim of this study was to test the effectiveness of a triple monitoring (TM), i.e., a combination of ultrasound (US), nerve stimulation (NS) and opening injection pressure (OIP) during interscalene brachial plexus block (IBPB) for surgery of the shoulder. Sixty patients undergoing IBPB for shoulder arthroscopy received TM. BSmart®, an inline injection device connected to a 10 mL syringe, was used to detect OIP during IBPB. Nerve stimulation was set to 0.5 mA to rule out any motor response, and if OIP was below 15 PSI, 10 mL of local anaesthetic was injected under US guidance between the C5 and C6 roots. The main outcome was the ability of TM to detect a needle–nerve contact. Other outcomes including the duration of IBPB; pain during injection; postoperative neurologic dysfunction. Triple monitoring revealed needle–nerve contact in 33 patients (55%). In 18 patients, NS evoked motor responses despite first control with US; in a further 15 patients, BSmart® detected an OIP higher than 15 PSI, despite the absence of motor response to NS. Mean duration of IBPB was 67.2 ± 5.3 seconds; neither pain during injection nor postoperative neurologic dysfunctions were detected. Clinical follow up excluded the presence of postoperative neuropathies. Triple monitoring showed to be a useful and feasible tool while performing IBPB for arthroscopic shoulder surgery. Future studies will be needed to confirm our findings.

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Reducing the risk of neurological complications after peripheral nerve block: what is the role of pressure monitoring?

Cited by 12 publications

References 27 publications

Establishment of ultrasound-guided stellate ganglion block in rats

Establishment of ultrasound-guided stellate ganglion block in rats

Guidelines for the safe clinical practice of peripheral nerve blocks in the adult patient

Triple Monitoring May Avoid Intraneural Injection during Interscalene Brachial Plexus Block for Arthroscopic Shoulder Surgery: A Prospective Preliminary Study

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