Case report: Neurological deficit associated with intraneural needle placement without injection
Tóm tắt
Recent reports of painless intraneural injection of low volumes of local anesthetic without subsequent neurological deficit have led to the suggestion that deliberate subepineural injection may be a safe and therefore acceptable practice. This report describes a case where a venous cannulation needle inadvertently penetrated a patient’s median nerve. Sudden onset severe lancinating pain occurred in the median nerve sensory distribution. A subsequent thorough ultrasound examination showed the median nerve to be located immediately posterior to the targeted median cubital vein. New onset sensory symptoms (numbness, tingling, pain, and altered sensation to touch) in the distribution of the penetrated median nerve persisted for >6 weeks. This report highlights the hazards of intraneural needle placement irrespective of an associated injection.
Tài liệu tham khảo
Bigeleisen PE. Nerve puncture and apparent intraneural injection during ultrasound-guided axillary block does not invariably result in neurologic injury. Anesthesiology 2006; 105: 779–83.
Brull R, Chan VW, McCartney CJ, Perlas A, Xu D. Ultrasound detects intraneural injection. Anesthesiology 2007; 106: 1244; author reply 1247.
Rodriguez J, Taboada M, Blanco M, Oliveira J, Barcena M, Alvarez J. Intraneural catheterization of the sciatic nerve in humans: a pilot study. Reg Anesth Pain Med 2008; 33: 285–90.
Russon K, Blanco R. Accidental intraneural injection into the musculocutaneous nerve visualized with ultrasound. Anesth Analg 2007; 105: 1504–5.
Sala-Blanch X, Pomes J, Matute P, et al. Intraneural injection during anterior approach for sciatic nerve block. Anesthesiology 2004; 101: 1027–30.
Schafhalter-Zoppoth I, Zeitz ID, Gray AT. Inadvertent femoral nerve impalement and intraneural injection visualized by ultrasound. Anesth Analg 2004; 99: 627–8.
Tsui BC, Dillane D. Needle puncture site and a “walkdown” approach for short-axis alignment during ultrasound-guided blocks. Reg Anesth Pain Med 2006; 31: 586–7.
Sala Blanch X, Lopez AM, Carazo J, et al. Intraneural injection during nerve stimulator-guided sciatic nerve block at the popliteal fossa. Br J Anaesth 2009; 102: 855–61.
Bigeleisen PE, Rosenblatt MA. Ultrasound-guided intraneural injection for regional anesthesia: Pro. ASRA News. Available from URL: www.asra.com/publications/newletter.php 2009; February: 6 (accessed August 2009).
Inglis JT, Leeper JB, Wilson LR, Gandevia SC, Burke D. The development of conduction block in single human axons following a focal nerve injury. J Physiol 1998; 513(Pt 1): 127–33.
Eckberg DL, Wallin BG, Fagius J, Lundberg L, Torebjork HE. Prospective study of symptoms after human microneurography. Acta Physiol Scand 1989; 137: 567–9.
Rice AS, Andreev NY, McMahon SB. The consequences of microneurography electrode-induced injury of peripheral nerves observed in the rat and man. Pain 1994; 59: 385–93.
Rice AS, McMahon SB. Peripheral nerve injury caused by injection needles used in regional anaesthesia: influence of bevel configuration, studied in a rat model. Br J Anaesth 1992; 69: 433–8.
Selander D, Dhuner KG, Lundborg G. Peripheral nerve injury due to injection needles used for regional anesthesia. An experimental study of the acute effects of needle point trauma. Acta Anaesthesiol Scand 1977; 21: 182–8.
Sala-Blanch XR, Ribata T, Rivas E, et al. A structural injury to the human sciatic nerve after intraneural needle insertion. Reg Anesth Pain Med 2009; 34: 201–5.
Maruyama M. Long-tapered double needle used to reduce needle stick nerve injury. Reg Anesth 1997; 22: 157–60.
Moore DC, Mulroy MF, Thompson GE. Peripheral nerve damage and regional anaesthesia. Br J Anaesth 1994; 73: 435–6.
Kaufman BR, Nystrom E, Nath S, Foucher G, Nystrom A. Debilitating chronic pain syndromes after presumed intraneural injections. Pain 2000; 85: 283–6.
Auroy Y, Benhamou D, Bargues L, et al. Major complications of regional anesthesia in France: The SOS Regional Anesthesia Hotline Service. Anesthesiology 2002; 97: 1274–80.
Capdevila X, Pirat P, Bringuier S, et al. Continuous peripheral nerve blocks in hospital wards after orthopedic surgery: a multicenter prospective analysis of the quality of postoperative analgesia and complications in 1,416 patients. Anesthesiology 2005; 103: 1035–45.
Graif M, Seton A, Nerubai J, Horoszowski H, Itzchak Y. Sciatic nerve: sonographic evaluation and anatomic-pathologic considerations. Radiology 1991; 181: 405–8.
Fremling MA, Mackinnon SE. Injection injury to the median nerve. Ann Plast Surg 1996; 37: 561–7.
Shah S, Hadzic A, Vloka JD, Cafferty MS, Moucha CS, Santos AC. Neurologic complication after anterior sciatic nerve block. Anesth Analg 2005; 100: 1515–7.
Bonner SM, Pridie AK. Sciatic nerve palsy following uneventful sciatic nerve block. Anaesthesia 1997; 52: 1205–7.