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Minerva Anestesiol 2022 Mar 24;88(3):166-172. Epub 2022 Jan 24.

Department of Anesthesiology, Pain Management and Intensive Care Medicine, Clinical Hospital of Barcelona, Barcelona, Spain.

Introduction: Ultrasonography is useful for detecting intraneural injections. However, the reliability of the sonographic findings of intraneural and subparaneural injections in terms of true spread location and their association with intrafascicular deposits has not been systematically evaluated.

Evidence Acquisition: Our objectives were: 1) to explore the reliability of sonographic findings of intraneural and subparaneural injections when validated with tests of true spread such as histology, dissection, or imaging; and 2) to evaluate their association with intrafascicular deposits. Read More

Anesth Analg 2021 02;132(2):556-565

From the Department of Anesthesiology and Critical Care Medicine, Lapeyronie University Hospital, Montpellier Cedex 5, France.

Background: Nerve damage can occur after peripheral nerve block (PNB). Ultrasound guidance does not eliminate the risk of intraneural injection or nerve injury. Combining nerve stimulation and injection pressure (IP) monitoring with ultrasound guidance has been suggested to optimize needle tip location in PNB. Read More

Front Vet Sci 2020 12;7:217. Epub 2020 May 12.

Department of Medicine and Animal Surgery, Faculty of Veterinary Science, University of Murcia, Murcia, Spain.

Ultrasound (US)-guided techniques for peripheral nerve blockade have revealed that intraneural injections are relatively frequent and not necessarily associated with neurological deficits. To evaluate the short-term effects of deliberate injections performed under direct vision in two different sites of the sciatic nerve (ScN). Seventy-two New Zealand white rabbits randomly assigned to one of four experimental groups ( = 18) were employed. Read More

Anesth Analg 2019 06;128(6):e104-e108

From the Department of Anesthesiology, University of California, San Diego, California.

We tested the hypothesis that during a continuous popliteal-sciatic nerve block, postoperative analgesia is improved with the catheter insertion point "deep" to the paraneural sheath immediately distal to the bifurcation between the tibial and common peroneal branches, compared with the traditional approach "superficial" to the paraneural sheath proximal to the bifurcation. The needle tip location was determined to be accurately located with a fluid bolus visualized with ultrasound; however, catheters were subsequently inserted without a similar fluid injection and visualization protocol (visualized air injection was permitted and usually implemented, but not required per protocol). The average pain (0-10 scale) the morning after surgery for subjects with a catheter inserted at the proximal subparaneural location (n = 31) was a median (interquartile) of 1. Read More

Reg Anesth Pain Med 2017 Sep/Oct;42(5):556-563

From the *Department of Anesthesiology, McGill University, Montreal, Quebec, Canada; †Division of Acute and Perioperative Pain Medicine, University of Florida College of Medicine, Gainesville, FL; and ‡Department of Anesthesiology, Virginia Mason Medical Center, Seattle, WA.

Despite its popularity, ultrasound (US)-guided regional anesthesiology is associated with significant limitations. The latter can be attributed to either the US machine (ie, decreased ability to insonate deep neural structures, as well as the thoracic spine) or the operator. Shortcomings associated with the operator can be explained by errors in perception (ie, ambiguous criteria for needle/catheter tip-to-nerve proximity and subparaneural local anesthetic injection) or interpretation. Read More