Department of Anesthesia and Chronic Pain Service, St. George's University Hospital, London, UK -
St. George's University of London, London, UK.
Minerva Anestesiol. 2018 Aug;84(8):907-918. doi: 10.23736/S0375-9393.18.12230-9. Epub 2018 Jan 16.
The aim of the study was to investigate the difference between intraneural and perineural injection pressures in human cadavers. Targeted nerves included the cervical roots, the supraclavicular and infraclavicular brachial plexus, the sciatic-subgluteal nerve and the common peroneal and tibial nerves.
Ten readings were obtained for each nerve location. Over ten seconds, 1 mL of 0.9% NaCl was injected - deliberately slower than in clinical practice to eliminate the risk of aberrant readings relating to the speed of injection. Perineural injections occurred at least 1 mm outside the epineurium. After pressure recordings were completed 0.1mL of dye was injected, and dissection performed to confirm needle placement. Ultrasound and dissection images were matched with light microscopy pictures for all locations.
The average pressure for intraneural injections was 24.1±5.7 psi and 6.1±2.1 psi for perinereural. The average injection pressure generated for the cervical trunk, supraclavicular, infraclavicular, sciatic subgluteal, peroneal and tibial nerves respectively were 31.2±6.0 psi, 24±15.0 psi, 23.4±9.5 psi, 22.6±8.8 psi 19.7±6 psi, 17±7.3 psi intraneurally and 6.1±2.0 psi, 9.1±5.5 psi, 10±4.9 psi, 6±2.4 psi, 6±2.4 psi and 7±2.5 psi perineurally. For intraneural injections statistically significant differences were demonstrated between the peroneal and tibial nerves compared to cervical roots/trunks/division/cords of brachial plexus.
The study has consistently demonstrated statistically significant differences between intraneural and perineural injection pressures. It effectively created a "map" of intraneural injection pressures for the most common peripheral nerves blocks and demonstrated a pattern between proximal and distal locations. The study also revealed limitations of either techniques, ultrasound and injection pressure monitoring reinforcing the concept of their simultaneous application.
本研究旨在探讨人体尸体中神经内和神经周围注射压力的差异。目标神经包括颈神经根、锁骨上和锁骨下臂丛神经、坐骨-臀下神经以及腓总神经和胫神经。
对每个神经位置进行了十次读数。在超过十秒钟的时间内，注射 1 毫升 0.9%氯化钠 - 故意注射得更慢，以消除与注射速度有关的异常读数的风险。神经周围注射发生在神经外膜至少 1 毫米之外。完成压力记录后，注射 0.1 毫升染料，并进行解剖以确认针的位置。所有位置的超声和解剖图像均与光镜照片匹配。
神经内注射的平均压力为 24.1±5.7 psi，神经周围注射的平均压力为 6.1±2.1 psi。颈干、锁骨上、锁骨下、坐骨臀下、腓总神经和胫神经的平均注射压力分别为 31.2±6.0 psi、24±15.0 psi、23.4±9.5 psi、22.6±8.8 psi、19.7±6 psi、17±7.3 psi 神经内和 6.1±2.0 psi、9.1±5.5 psi、10±4.9 psi、6±2.4 psi、6±2.4 psi 和 7±2.5 psi 神经周围。与颈神经根/干/分支/臂丛神经相比，腓总神经和胫神经的神经内注射压力存在统计学显著差异。
本研究一致表明神经内和神经周围注射压力之间存在统计学显著差异。它有效地为最常见的周围神经阻滞创建了神经内注射压力“地图”，并显示了近端和远端位置之间的模式。该研究还揭示了两种技术（超声和注射压力监测）的局限性，这加强了同时应用这两种技术的概念。
