Histological confirmation of needle tip position during ultrasound-guided interscalene block: a randomized comparison between the intraplexus and the periplexus approach

Canadian Journal of Anaesthesia = Journal Canadien D'anesthésie
Jennifer J SzerbKim Wong

Abstract

Ultrasound-guided interscalene block can be performed using either periplexus or intraplexus needle placement. In this novel study, we histologically examined the needle tip position in relation to the neural tissues with the two techniques. Our objective was to investigate the variable risk of subepineurial needle tip placement resulting from the two ultrasound-guided techniques. In an embalmed cadaveric model, periplexus or intraplexus interscalene injections were performed with the side, order, and technique assigned randomly. Under real-time ultrasound guidance, the block needle was placed next to the hyperechoic layer of the plexus (periplexus) or between the hypoechoic nerve roots (intraplexus). Once positioned, 0.1 mL of black acrylic ink was injected. The brachial plexus tissues were then removed and histology sections were prepared and then coded in order to blind two reviewers to group allocation. The area of ink staining was used to determine needle tip location, and the groups were compared for the presence of subepineurial ink. Twenty-six cadavers had each of the blocks performed on either brachial plexus (i.e., 52 injections). No subepineurial ink deposits were observed in the periplexus group (0%), but subepineur...Continue Reading

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Citations

Jun 14, 2017·Anaesthesia·J Szerb, M Kwesi Kwofie
Jun 14, 2017·Anaesthesia·L Sermeus, X Sala-Blanch
Feb 17, 2017·Regional Anesthesia and Pain Medicine·Steven L Orebaugh, Paul E Bigeleisen
Sep 13, 2017·British Journal of Hospital Medicine·Henry Wang, Paul Clements
Feb 7, 2018·Pain Medicine : the Official Journal of the American Academy of Pain Medicine·Luc A SermeusMarcel P Vercauteren
Apr 18, 2019·Regional Anesthesia and Pain Medicine·Jennifer SzerbVishal Uppal
Apr 22, 2021·Canadian Journal of Anaesthesia = Journal Canadien D'anesthésie·Jonathan G BaileyVishal Uppal
Jun 22, 2021·Journal of Controlled Release : Official Journal of the Controlled Release Society·Adam J S McCartanRandall J Mrsny

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