Department of Anesthesia, Bellinzona Regional Hospital, Bellinzona, Switzerland.
Department of Anesthesia, Lugano Regional Hospital, Lugano, Switzerland.
Acta Anaesthesiol Scand. 2020 Nov;64(10):1513-1518. doi: 10.1111/aas.13681. Epub 2020 Aug 19.
Injection pressure monitoring can help detecting the needle tip position and avoid intraneural injection. However, it shall be measured at the needle tip in order to be accurate and reproducible with any injection system and non operator-dependent. With an innovative system monitoring the injection pressure right at the needle tip we show that it is possible to early detect an intraneural and also an intravascular injection.
We performed supraclavicular block-like procedures under real-time ultrasound guidance on two fresh cadaver torsos using a sensing needle with an optical fiber pressure sensor within the shaft continuously measuring injection pressure at the needle tip. A total of 45 ultrasound-guided injections were performed (15 perineural, 15 intraneural and 15 intravenous injections).
Mean (SD) injection pressure after only 1 mL injected volume was already significantly higher for the intraneural compared to the perineural injections: 70.46 kPa (11.72) vs 8.34 (4.68) kPa; P < .001. Mean (SD) injection pressure at 1 mL injected volume was significantly lower for the intravascular compared to the perineural injections: 1.51 (0.48) vs 8.34 (4.68) kPa; P < .001.
Our results show that injection pressure monitoring at the needle tip has the potential to help identifying an accidental intraneural or intravascular injection at a very early stage.
注射压力监测有助于发现针尖位置，避免神经内注射。然而，为了准确且可重现，无论使用何种注射系统，都应在针尖处测量。通过监测针尖处的注射压力的创新系统，我们证明了早期发现神经内和血管内注射是可能的。
我们在两个新鲜的尸体胸部上进行实时超声引导锁骨下阻滞样操作，使用带有光纤压力传感器的感测针，连续测量针尖处的注射压力。总共进行了 45 次超声引导注射（15 次神经周围，15 次神经内和 15 次静脉内注射）。
仅注射 1 毫升容量后，神经内注射的平均（标准差）注射压力明显高于神经周围注射：70.46 kPa（11.72）比 8.34 kPa（4.68）；P <.001。在注射 1 毫升容量时，血管内注射的平均（标准差）注射压力明显低于神经周围注射：1.51 kPa（0.48）比 8.34 kPa（4.68）；P <.001。
我们的结果表明，针尖处的注射压力监测有可能帮助早期识别意外的神经内或血管内注射。
