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MINERVA ANESTESIOLOGICA

Rivista di Anestesia, Rianimazione, Terapia Antalgica e Terapia Intensiva


Official Journal of the Italian Society of Anesthesiology, Analgesia, Resuscitation and Intensive Care
Indexed/Abstracted in: Current Contents/Clinical Medicine, EMBASE, PubMed/MEDLINE, Science Citation Index Expanded (SciSearch), Scopus
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Minerva Anestesiologica 2018 Jan 16

DOI: 10.23736/S0375-9393.18.12230-9

Copyright © 2018 EDIZIONI MINERVA MEDICA

lingua: Inglese

Injection pressure mapping of intraneural vs. perineural injections: further lessons from cadaveric studies

Andrzej KROL 1 , Arber VALA 2 , Leonidas PHYLACTIDES 1, Matthew SZARKO 2 , Miguel A. REINA 3 , Jose de ANDRÉS 4

1 Department of Anaesthesia and Chronic Pain Service, St George’s University Hospital, London, UK; 2 St George’s University of London, London, UK; 3 Department of Anesthesiology, Madrid-Monteprincipe University Hospital, Madrid, Spain; School of Medicine, CEU San Pablo University, Madrid, Spain; 4 Department of Anesthesia Critical Care and Pain Management, School of Medicine, University of Valencia, Valencia, Spain


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BACKGROUND: The aim of the study was to investigate the difference between intraneural and perineural injection pressures in human cadavers. Targeted nerves included the cervical roots, the supraclavicular and infraclavicular brachial plexus, the sciatic-subgluteal nerve and the common peroneal and tibial nerves.
METHODS: Ten readings were obtained for each nerve location. 1mL of 0.9% NaCl was injected over ten seconds - deliberately slower than in clinical practice to eliminate the risk of aberrant readings relating to the speed of injection. Perineural injections occurred at least 1 mm outside the epineurium. After pressure recordings were completed 0.1ml of dye was injected and dissection performed to confirm needle placement. Ultrasound and dissection images were matched with light microscopy pictures for all locations.
RESULTS: The average pressure for intraneural injections was 24.1±5.7 psi and 6.1±2.1psi for perinereural. The average injection pressure generated for the cervical trunk, supraclavicular, infraclavicular, sciatic subgluteal, peroneal and tibial nerves respectively were 31.2±6.0psi, 24±15.0psi, 23.4±9.5psi, 22.6±8.8psi 19.7±6psi, 17±7.3psi intraneurally and 6.1±2.0psi, 9.1±5.5psi, 10±4.9psi, 6±2.4psi, 6±2.4psi and 7±2.5psi perineurally. For intraneural injections statistically significant differences were demonstrated between the peroneal and tibial nerves compared to cervical roots/ trunks /division/cords of brachial plexus.
CONCLUSIONS: The study has consistently demonstrated statistically significant differences between intraneural and perineural injection pressures. It effectively created a "map" of intraneural injection pressures for the most common peripheral nerves blocks and demonstrated a pattern between proximal and distal locations. The study also revealed limitations of either techniques, ultrasound and injection pressure monitoring reinforcing the concept of their simultaneous application.


KEY WORDS: Intraneural - Perineural - Injection pressure - Peripheral nerves - Ultrasound - Mapping

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Publication History

Article first published online: January 16, 2018
Manuscript accepted: January 10, 2018
Manuscript revised: November 15, 2017
Manuscript received: June 11, 2017

Per citare questo articolo

Krol A, Vala A, Phylactides L, Szarko M, Reina MA, De Andres J. Injection pressure mapping of intraneural vs. perineural injections: further lessons from cadaveric studies. Minerva Anestesiol 2018 Jan 16. DOI: 10.23736/S0375-9393.18.12230-9

Corresponding author e-mail

andrzej.krol@stgeorges.nhs.uk