Anesthesiology and Pain Medicine

Published by: Kowsar

Pressure Monitoring of Intraneural an Perineural Injections Into the Median, Radial, and Ulnar Nerves; Lessons From a Cadaveric Study

Andrzej Krol 1 , * , Matthew Szarko 2 , Arber Vala 2 and Jose De Andres 3
Authors Information
1 Department of Anaesthesia and Chronic Pain Service, St Georges Hospital, London, United Kingdom
2 St George’s University of London, London, United Kingdom
3 Department of Anaesthesia Critical Care and Pain Management, School of Medicine, University of Valencia, General University Hospital, Valencia, Spain
Article information
  • Anesthesiology and Pain Medicine: June 01, 2015, 5 (3); e22723
  • Published Online: June 22, 2015
  • Article Type: Research Article
  • Received: August 12, 2014
  • Revised: October 17, 2014
  • Accepted: November 4, 2014
  • DOI: 10.5812/aapm.22723

To Cite: Krol A, Szarko M, Vala A, De Andres J. Pressure Monitoring of Intraneural an Perineural Injections Into the Median, Radial, and Ulnar Nerves; Lessons From a Cadaveric Study, Anesth Pain Med. 2015 ; 5(3):e22723. doi: 10.5812/aapm.22723.

Copyright © 2015, Iranian Society of Regional Anesthesia and Pain Medicine (ISRAPM). This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License ( which permits copy and redistribute the material just in noncommercial usages, provided the original work is properly cited.
1. Background
2. Objectives
3. Materials and Methods
4. Results
5. Discussion
  • 1. Montgomery SJ, Raj PP, Nettles D, Jenkins MT. The use of the nerve stimulator with standard unsheathed needles in nerve blockade. Anesth Analg. 1973; 52(5): 827-31[PubMed]
  • 2. Kapral S, Krafft P, Eibenberger K, Fitzgerald R, Gosch M, Weinstabl C. Ultrasound-guided supraclavicular approach for regional anesthesia of the brachial plexus. Anesth Analg. 1994; 78(3): 507-13[PubMed]
  • 3. Neal JM, Wedel DJ. Ultrasound guidance and peripheral nerve injury: is our vision as sharp as we think it is? Reg Anesth Pain Med. 2010; 35(4): 335-7[DOI][PubMed]
  • 4. Gadsden J, McCally C, Hadzic A. Monitoring during peripheral nerve blockade. Curr Opin Anaesthesiol. 2010; 23(5): 656-61[DOI][PubMed]
  • 5. Sala-Blanch X, Vandepitte C, Laur JJ, Horan P, Xu D, Reina MA, et al. A practical review of perineural versus intraneural injections: a call for standard nomenclature. Int Anesthesiol Clin. 2011; 49(4): 1-12[DOI][PubMed]
  • 6. Brull R, McCartney CJ, Chan VW, El-Beheiry H. Neurological complications after regional anesthesia: contemporary estimates of risk. Anesth Analg. 2007; 104(4): 965-74[DOI][PubMed]
  • 7. Barrington MJ, Watts SA, Gledhill SR, Thomas RD, Said SA, Snyder GL, et al. Preliminary results of the Australasian Regional Anaesthesia Collaboration: a prospective audit of more than 7000 peripheral nerve and plexus blocks for neurologic and other complications. Reg Anesth Pain Med. 2009; 34(6): 534-41[PubMed]
  • 8. Liu SS, Ngeow JE, Yadeau JT. Ultrasound-guided regional anesthesia and analgesia: a qualitative systematic review. Reg Anesth Pain Med. 2009; 34(1): 47-59[DOI][PubMed]
  • 9. Boezaart AP. That which we call a rose by any other name would smell as sweet-and its thorns would hurt as much. Reg Anesth Pain Med. 2009; 34(1): 3-7[DOI][PubMed]
  • 10. Auroy Y, Narchi P, Messiah A, Litt L, Rouvier B, Samii K. Serious complications related to regional anesthesia: results of a prospective survey in France. Anesthesiology. 1997; 87(3): 479-86[PubMed]
  • 11. Lee LA, Posner KL, Cheney FW, Caplan RA, Domino KB. Complications associated with eye blocks and peripheral nerve blocks: an american society of anesthesiologists closed claims analysis. Reg Anesth Pain Med. 2008; 33(5): 416-22[DOI][PubMed]
  • 12. Reiss W, Kurapati S, Shariat A, Hadzic A. Nerve injury complicating ultrasound/electrostimulation-guided supraclavicular brachial plexus block. Reg Anesth Pain Med. 2010; 35(4): 400-1[PubMed]
  • 13. Selander D, Sjostrand J. Longitudinal spread of intraneurally injected local anesthetics. An experimental study of the initial neural distribution following intraneural injections. Acta Anaesthesiol Scand. 1978; 22(6): 622-34[PubMed]
  • 14. Hadzic A, Dilberovic F, Shah S, Kulenovic A, Kapur E, Zaciragic A, et al. Combination of intraneural injection and high injection pressure leads to fascicular injury and neurologic deficits in dogs. Reg Anesth Pain Med. 2004; 29(5): 417-23[PubMed]
  • 15. 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[DOI][PubMed]
  • 16. Lupu CM, Kiehl TR, Chan VW, El-Beheiry H, Madden M, Brull R. Nerve expansion seen on ultrasound predicts histologic but not functional nerve injury after intraneural injection in pigs. Reg Anesth Pain Med. 2010; 35(2): 132-9[DOI][PubMed]
  • 17. Orebaugh SL, Mukalel JJ, Krediet AC, Weimer J, Filip P, McFadden K, et al. Brachial plexus root injection in a human cadaver model: injectate distribution and effects on the neuraxis. Reg Anesth Pain Med. 2012; 37(5): 525-9[DOI][PubMed]
  • 18. Gadsden JC, Choi JJ, Lin E, Robinson A. Opening injection pressure consistently detects needle-nerve contact during ultrasound-guided interscalene brachial plexus block. Anesthesiology. 2014; 120(5): 1246-53[DOI][PubMed]
  • 19. Controlled Disc Stimulation System Operation/ Service Manual 2005-2008. 2008;
  • 20. Vuckovic I, Hadzic A, Dilberovic F, Kulenovic A, Mornjakovic Z, Zulic I, et al. Detection of neurovascular structures using injection pressure in blockade of brachial plexus in rat. Bosn J Basic Med Sci. 2005; 5(3): 79-85[PubMed]
  • 21. Reina MA, Arriazu R, Collier CB, Sala-Blanch X, Izquierdo L, de Andres J. Electron microscopy of human peripheral nerves of clinical relevance to the practice of nerve blocks. A structural and ultrastructural review based on original experimental and laboratory data. Rev Esp Anestesiol Reanim. 2013; 60(10): 552-62[DOI][PubMed]
  • 22. Chan VW, Brull R, McCartney CJ, Xu D, Abbas S, Shannon P. An ultrasonographic and histological study of intraneural injection and electrical stimulation in pigs. Anesth Analg. 2007; 104(5): 1281-4[DOI][PubMed]
  • 23. Claudio R, Hadzic A, Shih H, Vloka JD, Castro J, Koscielniak-Nielsen Z, et al. Injection pressures by anesthesiologists during simulated peripheral nerve block. Reg Anesth Pain Med. 2004; 29(3): 201-5[PubMed]
  • 24. Macfarlane AJ, Bhatia A, Brull R. Needle to nerve proximity: what do the animal studies tell us? Reg Anesth Pain Med. 2011; 36(3): 290-302[DOI][PubMed]
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