Abstract
The blockade of peripheral nerves carries a certain risk of unwanted complications, which can follow after unintentional intraneural injection of a local anesthetic. Up till today, the research of measuring injection pressure has been based on animal models, even though the histological structure of periphery nerve is different for animal and human population, so the application pressure which presages intraneural injection in human population is still unknown. As material in performing this study there have been used 12 Wistar rats and 12 delivered stillborns. After bilateral access to the median nerve, we applied 3 ml of 2% lidocaine with epinephrine, with the help of automatic syringe charger. The needle was at first placed perineural on one side, and then intraneural on the other side of both examination groups. During every application the pressure values were monitored using the manometer, and then they were analyzed by special software program BioBench. All perineural injections resulted with the pressure < or = 27.92 kPa, while the majority of intraneural injections were combined with the injection pressure > or = 69.8 kPa. The difference between intraneural and perineural injection pressures for the two different examination groups (rats and delivered stillborns) was not statistically significant (P>0.05). As prevention from intraneural injections today are in use two methods: the method of causing paresthesia or the method of using the peripheral nerve stimulator. However the nerve injury can still occur, independent from the technique used. If our results are used in clinical practice on human population, than the high injection pressure could be the marker of intraneural lodging of a needle.
Highlights
In the last few years there has been a great leap forward in the development of regional anesthesia
Even though all perineural injections resulted with the pressure ≤, kPa, the majority of intraneural injections were combined with the injection pressure ≥, kPa
There are many discussions about how to prevent intraneural injection and nerve injury combined with peripheral nerve block, and all these discussions are focused on the methods of nerve localization
Summary
In the last few years there has been a great leap forward in the development of regional anesthesia. Since the concept of ambulatory surgery and the concept of acute pain is developing, the equipment for regional anesthesia is improving, the new pharmacological resources and new techniques of regional anesthesia are being found ( ). Safer methods of access and outcome for patients are developing, and the advantages of regional anesthesia (more physiological and economical) are taken in consideration, while the general anesthesia is being pushed into the second plan. The blockade of peripheral nerves, as any other medical procedure, carries a certain risk of unwanted complications ( , , , , ). Perioperative neural injury after the blockade of peripheral nerves can be a result of several factors.These factors can be generally divided into two categories:. . Ones which are unconnected with the techniques of regional anesthesia and
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