Nerve Injury Resulting from Intraneural Injection When Performing Peripheral Nerve Block

Rakesh V. Sondekoppam; Ban C. H. Tsui

doi:10.1007/978-3-319-49386-2_5

Back

Book chapter

Nerve Injury Resulting from Intraneural Injection When Performing Peripheral Nerve Block

Rakesh V. Sondekoppam and Ban C. H. Tsui

Complications of Regional Anesthesia, pp.67-101

Springer International Publishing

05/04/2017

DOI: 10.1007/978-3-319-49386-2_5

View Online

Abstract

A neuronal injury can be explained using an epidemiological triad model as an interaction between an injurious agent (local anesthetic/needle or pressure injury), a susceptible host (inadequately protected nerve), and a hazardous working environment (poor supervision/guidance for locating needle; unsafe practices, unintended exposure). In theory, elimination of one of the triad’s components should prevent the occurrence of the event.Long-term neurologic complications (lasting more than 6 months) are rare following peripheral nerve blocks while the short-term neurologic symptoms although more common are known to resolve within a few weeks to 3 months.Most of the evidence regarding needle, pressure, and local anesthetic-related injuries comes from animal studies.In clinical practice, it is difficult to stay extraneurally all the time and intraneural injections do occur while performing PNB.To minimize the risk of neurological injury, one must evaluate the patient properly (preprocedural examination to ensure no preexisting neuropathy/risk factors), select equipment appropriately (needle gauge, type), and administer local anesthetic accordingly (lower concentration for nerves susceptible to insults).Allow a sufficient follow-up period particularly if paresthesia is noted during the procedure.Utilize all available guidance methods if possible for the performance of PNB including US, injection pressure monitoring, and neurostimulation.

Epidemiological triad

Injection pressure monitoring

Intraneural injections

Nerve stimulation

Neurologic complications

Ultrasound

Details

Title: Subtitle: Nerve Injury Resulting from Intraneural Injection When Performing Peripheral Nerve Block
Creators: Rakesh V. Sondekoppam - University of Alberta
Ban C. H. Tsui - Stanford University
Resource Type: Book chapter
Publication Details: Complications of Regional Anesthesia, pp.67-101
DOI: 10.1007/978-3-319-49386-2_5
Publisher: Springer International Publishing; Cham
Language: English
Date published: 05/04/2017
Academic Unit: Anesthesia
Record Identifier: 9984296131602771

Metrics

17 Record Views