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Ultrasonographic appearance of intraneural injections in the porcine model.

Publication ,  Journal Article
Altermatt, FR; Cummings, TJ; Auten, KM; Baldwin, MF; Belknap, SW; Reynolds, JD
Published in: Reg Anesth Pain Med
2010

BACKGROUND: Ultrasonographic (US) images of apparent intraneural injection of local anesthetic solutions have been reported. We aimed to define US signs of intraneural (ie, subepineural) injection using a histologic standard in an animal model and compare these signs with other potential markers of intraneural injection, including low nerve stimulation current thresholds and high injection pressures. METHODS: In 6 anesthetized adult swine, bilateral brachial plexus and femoral nerves were contacted by needles and penetrated. India ink was injected intraneurally under US monitoring. The minimum current that elicited a motor response was recorded. Injection pressures were measured using a digital manometer. Nerves were then excised, processed, and subjected to histologic analysis. RESULTS: Nerve expansion during injection was visualized under ultrasonography in all procedures. Electrical current intensity to elicit motor response to nerve stimulation varied between 0.2 and 3.3 mA with the needle tip positioned intraneurally. The mean injection pressure was 7.40 +/- 8.07 psi (range, 0.07-31.5 psi), with 80% of injections between 0.61 and 15.0 psi. None of 24 intraneural injections resulted in histologic evidence of intrafascicular injection (95% confidence interval, 0.0%-16.3%). CONCLUSIONS: Ultrasonographic images compatible with nerve swelling during an injection are consistent with true intraneural injections as demonstrated by histologic analysis. Under the conditions studied, intensity of the stimulating current required to elicit motor response was not associated with intraneural needle placement. In the absence of fascicular injury, intraneural injections were associated with low injection pressure, although false-positive results can occur.

Duke Scholars

Published In

Reg Anesth Pain Med

DOI

EISSN

1532-8651

Publication Date

2010

Volume

35

Issue

2

Start / End Page

203 / 206

Location

England

Related Subject Headings

  • Wounds, Penetrating
  • Ultrasonography, Interventional
  • Swine
  • Nerve Block
  • Needles
  • Femoral Nerve
  • Electric Stimulation
  • Brachial Plexus
  • Animals
  • Anesthesiology
 

Citation

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Altermatt, F. R., Cummings, T. J., Auten, K. M., Baldwin, M. F., Belknap, S. W., & Reynolds, J. D. (2010). Ultrasonographic appearance of intraneural injections in the porcine model. Reg Anesth Pain Med, 35(2), 203–206. https://doi.org/10.1097/AAP.0b013e3181d28396
Altermatt, Fernando R., Thomas J. Cummings, Kathryn M. Auten, Mathew F. Baldwin, Samuel W. Belknap, and James D. Reynolds. “Ultrasonographic appearance of intraneural injections in the porcine model.Reg Anesth Pain Med 35, no. 2 (2010): 203–6. https://doi.org/10.1097/AAP.0b013e3181d28396.
Altermatt FR, Cummings TJ, Auten KM, Baldwin MF, Belknap SW, Reynolds JD. Ultrasonographic appearance of intraneural injections in the porcine model. Reg Anesth Pain Med. 2010;35(2):203–6.
Altermatt, Fernando R., et al. “Ultrasonographic appearance of intraneural injections in the porcine model.Reg Anesth Pain Med, vol. 35, no. 2, 2010, pp. 203–06. Pubmed, doi:10.1097/AAP.0b013e3181d28396.
Altermatt FR, Cummings TJ, Auten KM, Baldwin MF, Belknap SW, Reynolds JD. Ultrasonographic appearance of intraneural injections in the porcine model. Reg Anesth Pain Med. 2010;35(2):203–206.

Published In

Reg Anesth Pain Med

DOI

EISSN

1532-8651

Publication Date

2010

Volume

35

Issue

2

Start / End Page

203 / 206

Location

England

Related Subject Headings

  • Wounds, Penetrating
  • Ultrasonography, Interventional
  • Swine
  • Nerve Block
  • Needles
  • Femoral Nerve
  • Electric Stimulation
  • Brachial Plexus
  • Animals
  • Anesthesiology