Ultrasound-guided block and the incidence of intraneural injection. A reply

Sermeus, Luc; Sala‐Blanch, Xavier

doi:10.1111/anae.13946

Cited by 5 publications

(3 citation statements)

References 7 publications

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“…We hypothesise that this rotational and displacement response mechanism reduces subepineural and intrafascicular injection, and provides evidence to support the use of a tangential approach towards nerves. 30 Nerve expansion confirmed clinical observations using small test doses. Cross-sectional area increased 113% after 0.5 ml and 232% after total 1 ml injection.…”

Section: Strengths and Weaknesses Of The Studysupporting

confidence: 65%

Real-time visualisation of peripheral nerve trauma during subepineural injection in pig brachial plexus using micro-ultrasound

Chandra

Soenjaya

Yan

et al. 2021

British Journal of Anaesthesia

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Section: Strengths and Weaknesses Of The Studysupporting

confidence: 65%

Real-time visualisation of peripheral nerve trauma during subepineural injection in pig brachial plexus using micro-ultrasound

Chandra

Soenjaya

Yan

et al. 2021

British Journal of Anaesthesia

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“…On the other hand it is very difficult to judge during an ultrasound guided procedure where exactly the needle tip is. In clinical practice, despite real‐time visualization of the needle tip with ultrasound, needle to nerve contact or epineurium perforation, cannot be prevented . Unintentional intraneural injection occurs at an incidence rate of 16.3% for the ultrasound‐guided subgluteal approach to the sciatic nerve .…”

Section: Discussionmentioning

confidence: 99%

Optical signature of nerve tissue—Exploratory ex vivo study comparing optical, histological, and molecular characteristics of different adipose and nerve tissues

et al. 2018

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BackgroundDuring several anesthesiological procedures, needles are inserted through the skin of a patient to target nerves. In most cases, the needle traverses several tissues—skin, subcutaneous adipose tissue, muscles, nerves, and blood vessels—to reach the target nerve. A clear identification of the target nerve can improve the success of the nerve block and reduce the rate of complications. This may be accomplished with diffuse reflectance spectroscopy (DRS) which can provide a quantitative measure of the tissue composition. The goal of the current study was to further explore the morphological, biological, chemical, and optical characteristics of the tissues encountered during needle insertion to improve future DRS classification algorithms.MethodsTo compare characteristics of nerve tissue (sciatic nerve) and adipose tissues, the following techniques were used: histology, DRS, absorption spectrophotometry, high‐resolution magic‐angle spinning nuclear magnetic resonance (HR‐MAS NMR) spectroscopy, and solution 2D 13C‐1H heteronuclear single‐quantum coherence spectroscopy. Tissues from five human freshly frozen cadavers were examined.ResultsHistology clearly highlights a higher density of cellular nuclei, collagen, and cytoplasm in fascicular nerve tissue (IFAS). IFAS showed lower absorption of light around 1200 nm and 1750 nm, higher absorption around 1500 nm and 2000 nm, and a shift in the peak observed around 1000 nm. DRS measurements showed a higher water percentage and collagen concentration in IFAS and a lower fat percentage compared to all other tissues. The scattering parameter (b) was highest in IFAS. The HR‐MAS NMR data showed three extra chemical peak shifts in IFAS tissue.ConclusionCollagen, water, and cellular nuclei concentration are clearly different between nerve fascicular tissue and other adipose tissue and explain some of the differences observed in the optical absorption, DRS, and HR‐NMR spectra of these tissues. Some differences observed between fascicular nerve tissue and adipose tissues cannot yet be explained but may be helpful in improving the discriminatory capabilities of DRS in anesthesiology procedures. Lasers Surg. Med. 50:948–960, 2018. © 2018 The Authors. Lasers in Surgery and Medicine Published by Wiley Periodicals, Inc.

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“…Other authors suggest the use of ultrasound to stay farer away from the nerval borders altogether 115 . We know that all local anesthetics can be neurotoxic to different degrees 116,117,118 . As this is a dose dependent effect, reducing concentration and volume -a proved advantage of USGRA -may reduce the risk of nerve damage.…”

Section: Further Ultrasound Related Approaches To Avoid Nerve Injurymentioning

confidence: 99%

Ultrasound guided regional anesthesia: What we know, what we think we know, what we don't know yet: Running title USGRA: Overview about facts and questions: An educational narrative review of literature

Huppertz-Thyssen,

Nikolić

2023

Serb J Anest Inten Therapy

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The introduction of ultrasound guidance over the last two decades brought progress, new blocks and new challenges to Regional Anesthesia. This narrative review addresses and discusses facts, frequent questions, beliefs, controversies, unsolved issues, open safety questions and existing knowledge gaps related to efficacy and safety of ultrasound guided regional anesthesia (USGRA), based on the available literature. We discuss evidence-based advantages and limitations of ultrasound guidance, as well as unresolved questions, with respect to successful anesthesia, undesired side effects and patient safety, like nerve injury and local anesthetic systemic toxicity (LAST). In an educational approach we also emphasize some practical aspects of our everyday experience as well as necessary structural requirements.

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Ultrasound-guided block and the incidence of intraneural injection. A reply

Cited by 5 publications

References 7 publications

Real-time visualisation of peripheral nerve trauma during subepineural injection in pig brachial plexus using micro-ultrasound

Real-time visualisation of peripheral nerve trauma during subepineural injection in pig brachial plexus using micro-ultrasound

Optical signature of nerve tissue—Exploratory ex vivo study comparing optical, histological, and molecular characteristics of different adipose and nerve tissues

Ultrasound guided regional anesthesia: What we know, what we think we know, what we don't know yet: Running title USGRA: Overview about facts and questions: An educational narrative review of literature

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