Injection pressure monitoring during peripheral nerve blocks: from bench to operating theatre

Autor: Mathieu Capdevila, Fabien Swisser, Martin Marques, Xavier Capdevila, Sophie Bringuier, Olivier Choquet, Andrea Saporito, Flora Djanikian
Přispěvatelé: Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Bellinzona Regional Hospital [Bellinzona], Institut des Neurosciences de Montpellier - Déficits sensoriels et moteurs (INM), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Montpellier (UM), Institut des Neurosciences de Montpellier (INM), CCSD, Accord Elsevier
Jazyk: angličtina
Rok vydání: 2020
Předmět:
Technology
Complications
medicine.medical_treatment
MESH: Ultrasonography
Interventional
Critical Care and Intensive Care Medicine
law.invention
Injections
03 medical and health sciences
Plateau pressure
0302 clinical medicine
030202 anesthesiology
Peripheral nerve
law
Cadaver
Medicine
Humans
MESH: Injections
Trial registration
Injection pressure
Saline
Ultrasonography
Interventional
Plexus
[SDV.MHEP] Life Sciences [q-bio]/Human health and pathology
MESH: Humans
business.industry
030208 emergency & critical care medicine
Nerve Block
General Medicine
MESH: Nerve Block
Sciatic Nerve
Nerve blocks
3. Good health
MESH: Sciatic Nerve
Anesthesiology and Pain Medicine
Pressure measurement
MESH: Needles
Needles
Anesthesia
business
Regional anaesthesia
[SDV.MHEP]Life Sciences [q-bio]/Human health and pathology
Zdroj: Anaesthesia Critical Care & Pain Medicine
Anaesthesia Critical Care & Pain Medicine, Elsevier Masson, 2020, 39 (5), pp.603-610. ⟨10.1016/j.accpm.2020.03.022⟩
ISSN: 2352-5568
DOI: 10.1016/j.accpm.2020.03.022⟩
Popis: International audience; Background: Nerve damage can occur after ultrasound-guided peripheral nerve block (PNB). Injection pressure monitoring could improve the safety of PNB. The aim was to analyse parameters affecting pressure measurements during PNB.Methods: The flow characteristics of needles connected to a pressure-sensing device were evaluated. Needles were placed under ultrasound guidance extra or epineurally in nerves/plexus of fresh cadavers. Using three flow rates, 4 mL of saline was injected and plateau pressure was measured. Finally, orthopaedic surgery patients receiving PNB were enrolled for an observational real-time pressure monitoring study. During PNB, periods with pressure > 50 mmHg were noted (high pressure ≥ 750 mmHg). A blinded investigator recorded injection pressure curves and peak pressure.Results: The needle diameter influenced the injection pressure (β = 66.8; P < 0.0001). Non-echogenic needles increased the injection pressure (β = 82; P = 0.0009) compared with echogenic needles. Cadaver injection pressure was higher for intraneural (255 [122.5-555] mmHg) versus extraneural needle tip location (90 [50-158] mmHg; P < 0001); for high flow (9.6 mL/min; 470 [265; 900] mmHg) versus low flow (1.2 mL/min; 120 [71-250] mmHg) (P < 0.001) and for cervical roots (900 mmHg, intraneurally) compared with nerves (300 mmHg, intraneurally). In 37 patients and 61 procedures, there were 7 [1-18] peaks of injection pressure per procedure. Pressure was noted > 750 mmHg during 13.80% of the procedural time.Conclusions: Needle diameter, needle tip location, type of nerve/plexus, flow rates, and the anaesthetist can have a significant effect on injection pressure values and monitoring.
Databáze: OpenAIRE
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