Reina Miguel A, Boezaart André P, Sala-Blanch Xavier, Monzó Enrique, Tubbs R Shane, Server Anna, Bigeleisen Paul
CEU San Pablo University School of Medicine, Madrid, Spain.
Department of Anesthesiology, Madrid-Montepríncipe University Hospital, Madrid, Spain.
Clin Anat. 2018 Oct;31(7):1050-1057. doi: 10.1002/ca.23253. Epub 2018 Oct 26.
Recent anatomical discoveries indicate the importance of identifying membranes and compartments surrounding peripheral nerves into which local anesthetic agents can be injected and continuous nerve block catheters placed during regional anesthetic procedures. However, current markers used in anatomical studies have multiple drawbacks, specifically extravasation into noninjected locations, which can result in inadequate treatment. We studied a readily-available new marker, heparinized blood solution (HBS), which is easy to identify by microscopy and can remain in the nerve compartment into which it is deposited without distorting the tissue. We collected blood from 22 patients and prepared it as HBS. This was then injected into four fresh cadavers as in routine clinical practice for ultrasound-guided nerve blocks to form a so-called "doughnut" by "hydro-dissecting" at 32 sites. All samples, including nerves and neighboring tissues, were then prepared and examined by light microscopy. Although no deliberate intraneural injection was attempted, the marker was identified inside all the nerve compartments except the fascicles. Apart from leaking through the needle entry site in some instances, there was no extravasation of the HBS into neighboring nerve compartments in either direction. The tissues were not distorted and the erythrocytes did not form a thrombus. Nerve membranes and compartments could be clearly identified with routine staining. This technique enabled us to study the longitudinal and circumferential spread in all nerve compartments and to collect data for better interpretation of factors influencing an anesthetic nerve block and situations in which complications could possibly arise. HBS seemed superior to other markers because it did not leave the compartments into which it had been injected, did not distort the tissue, and was easily visible under the light microscope. Clin. Anat., 31:1050-1057, 2018. © 2018 Wiley Periodicals, Inc.
近期的解剖学发现表明，在区域麻醉过程中，识别周围神经周围的膜和腔隙很重要，局部麻醉剂可注入这些腔隙，且可放置连续神经阻滞导管。然而，解剖学研究中使用的当前标记物存在多个缺点，特别是会渗入未注射的部位，这可能导致治疗不充分。我们研究了一种易于获得的新标记物，肝素化血液溶液（HBS），它通过显微镜易于识别，并且可以保留在其注入的神经腔隙中而不使组织变形。我们从22名患者采集血液并制备成HBS。然后按照超声引导神经阻滞的常规临床操作，将其注入4具新鲜尸体的32个部位，通过“水分离”形成所谓的“甜甜圈”。然后制备所有样本，包括神经和邻近组织，并进行光学显微镜检查。尽管未尝试故意进行神经内注射，但除了束状结构外，在所有神经腔隙内均识别出了该标记物。除了在某些情况下通过针头进入部位渗漏外，HBS没有向任何一个方向渗入邻近的神经腔隙。组织未变形，红细胞也未形成血栓。通过常规染色可以清晰地识别神经膜和腔隙。该技术使我们能够研究所有神经腔隙中的纵向和周向扩散情况，并收集数据以更好地解释影响麻醉性神经阻滞的因素以及可能出现并发症的情况。HBS似乎优于其他标记物，因为它不会离开其注入的腔隙，不会使组织变形，并且在光学显微镜下易于观察到。《临床解剖学》，31:1050 - 1057，2018年。© 2018威利期刊公司
