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- Graeme McLeod and Miguel A Reina.
- NHS Tayside, Ninewells Hospital, Dundee, UK; Imaging & Technology, University of Dundee, Dundee, UK; Engineering & Physical Sciences, Heriot-Watt University, Edinburgh, UK. Electronic address: g.a.mcleod@dundee.ac.uk.
- Br J Anaesth. 2024 May 1; 132 (5): 102210261022-1026.
AbstractHistological and micro-ultrasound evidence rebuffs deep-rooted views on the nature of nerve block, nerve damage, and injection pressure monitoring. We propose that the ideal position of the needle tip for nerve block is between the innermost circumneural fascial layer and outer epineurium, with local anaesthetic passing circumferentially through adipose tissue. Thin, circumferential, subepineural expansion that is invisible to the naked eye was identified using micro-ultrasound, and could account for variability of outcomes in clinical practice. Pressure monitoring cannot differentiate between intrafascicular and extrafascicular injection. High injection pressure only indicates intraneural extrafascicular spread, not intrafascicular spread, because it is not possible to inject into the stiff endoneurium in most human nerves.Copyright © 2023 British Journal of Anaesthesia. Published by Elsevier Ltd. All rights reserved.
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