Ultrasound‐guided perineural injection for nerve blockade: Does a single‐sided injection produce circumferential nerve coverage?

Abstract

Using clinical volumes of fluid, needle positioning at the deep surface of upper extremity and sciatic nerves was sufficient to produce circumferential coating of the nerve, except in the carpal tunnel, where placement of the needle between the nerve and flexor retinaculum is recommended. © 2016 Wiley Periodicals, Inc. J Clin Ultrasound 44:465-469, 2016.

Ultrasound‐Guided Subgluteal Sciatic Nerve Perineural Injection: Report on Safety and Efficacy at a Single Institution

“…The rate of technical success in this study also demonstrates the feasibility of this US‐guided approach, as long as an appropriate technique is adopted. A recently published cadaveric study confirmed circumferential coverage of the sciatic nerve with 5 mL of injectant using single‐side needle positioning during US‐guided subgluteal perineural injection, with proximal and distal perineural spread of the injectate for a length of 10 cm . However, another study in the anesthesiology literature discussed the need for multiple needle placements to get circumferential coverage of the sciatic nerve in the subgluteal region with 20 mL of injectant, reporting more effective nerve blocks with multiple needle placements .…”

“…A recently published cadaveric study confirmed circumferential coverage of the sciatic nerve with 5 mL of injectant using single-side needle positioning during US-guided subgluteal perineural injection, with proximal and distal perineural spread of the injectate for a length of 10 cm. 32 However, another study in the anesthesiology literature discussed the need for multiple needle placements to get circumferential coverage of the sciatic nerve in the subgluteal region with 20 mL of injectant, reporting more effective nerve blocks with multiple needle placements. 27 In our clinical experience, repositioning of the needle in multiple locations around the sciatic nerve during injection may be necessary for visual confirmation of circumferential perineural spread of the injectant (Figure 2).…”

Tibial Nerve Block Using an Ultrasound‐Guided Inframalleolar Medial Plantar Nerve Perineural Injection: A Technical Note

“…Repositioning was performed as needed to ensure that a full coverage of the tibial nerve was observed as described elsewhere . A recent cadaveric study by Nwawka and colleagues witnessed 100% circumferential distribution on CT following single‐side needle position of the radial, ulnar, and sciatic nerves as well as producing circumferential nerve coverage with an average length of spread of perineural injectate measuring 11.6 cm in the upper extremity and 10.3 cm for the sciatic nerves. It is important to note however that the perineural spread of injectate may differ in patients but real‐time US guidance can guide repositioning of the needle, if necessary.…”

Ultrasound-Guided Peripheral Nerve Injection Techniques

“…1) or between the nerve and the flexor retinaculum. In our experience, circumferential coverage of the nerve is more frequently achieved with the needle in the latter position using a clinical volume of 2 mL of the injectant [26]. Note that the patient is expected to experience temporary numbness in the hand after injection and therefore should be cautioned to…”

“…After the test injection, the desired injectant is deposited. We typically use a clinical injectant volume of 5 mL; in our investigations, 5 mL of injectant can produce up to 10 cm of segmental perineural spread [26]. The use of longacting anesthetic in this injection should be avoided because temporary leg weakness can occur after injection.…”