Department of Anesthesiology, University of Miami - Miller School of Medicine, Miami, Florida, USA
Department of Anesthesiology, University of Miami - Miller School of Medicine, Miami, Florida, USA.
Reg Anesth Pain Med. 2019 Jan;44(1):86-90. doi: 10.1136/rapm-2018-000026.
The exact mechanism of peripheral nerve blocks causing/leading to nerve injury remains controversial. Evidence from animal experiments suggests that intrafascicular injection resulting in high injection pressure has the potential to rupture nerve fascicles and may consequently cause permanent nerve injury and neurological deficits. The B-Smart (BS) in-line manometer and the CompuFlo (CF) computerized injection pump technology are two modalities used for monitoring pressure during regional anesthesia. This study sought to explore the accuracy of these two technologies in measuring needle-tip pressures in a simulated environment.
In seven simulated needle-syringe combinations, the BS and the CF devices were connected in series through a closed system and attached to a digital manometer at the tip of various needles. The pressures were evaluated in three trials per needle-syringe combination. Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy (F1 Score) were determined for each needle type and overall.
For pressures ≥15 psi and ≥20 psi, respectively, the CF device demonstrated a sensitivity of 100%, 100%; specificity of 96%, 98%; positive predictive value 93%, 93%; and negative predictive value of 100%, 100%. The BS device demonstrated a sensitivity of 60%, 100%; specificity of 99%, 95%; positive predictive value of 96%, 85%; and negative predictive value of 85%, 100%. Accuracy, as measured by the F1 Score, for detecting a pressure of ≥15 psi was 0.96 for the CF and 0.74 for the BS.
Future research is needed to explore in-vivo performance and evaluate whether either of these devices can impact on clinical outcomes.
外周神经阻滞导致神经损伤的确切机制仍存在争议。动物实验证据表明，腔内注射导致高注射压力有可能导致神经束破裂，并可能导致永久性神经损伤和神经功能缺损。B-Smart（BS）在线压力计和 CompuFlo（CF）计算机化注射泵技术是两种用于监测区域麻醉期间压力的技术。本研究旨在探讨这两种技术在模拟环境中测量针尖压力的准确性。
在七个模拟的针筒组合中，BS 和 CF 设备通过封闭系统串联连接，并在各种针的尖端连接到数字压力计。每个针筒组合进行三次试验评估压力。确定了每种针头类型和总体的灵敏度、特异性、阳性预测值、阴性预测值和准确性（F1 评分）。
对于分别≥15psi 和≥20psi 的压力，CF 设备的灵敏度为 100%、100%；特异性为 96%、98%；阳性预测值为 93%、93%；阴性预测值为 100%、100%。BS 设备的灵敏度为 60%、100%；特异性为 99%、95%；阳性预测值为 96%、85%；阴性预测值为 85%、100%。CF 检测≥15psi 压力的准确性，F1 评分为 0.96，BS 为 0.74。
需要进一步研究来探索体内性能，并评估这两种设备是否能影响临床结果。
