BACKGROUND AND OBJECTIVES: High injection pressures have been associated with intraneural injection and persistent neurological injury in animals. Our objective was to test whether a reported simple compressed air injection technique (CAIT) would limit the generation of injection pressures to below a suggested 1,034 mm Hg limit in an in vitro model. METHODS: After ethics board approval, 30 consenting anesthesiologists injected saline into a semiclosed system. Injection pressures using 30 mL syringes connected to a 22 gauge needle and containing 20 mL of saline were measured for 60 seconds using: (1) a typical "syringe feel" method, and (2) CAIT, thereby drawing 10 mL of air above the saline and compressing this to 5 mL prior to and during injections. All anesthesiologists performed the syringe feel method before introduction and demonstration of CAIT. RESULTS: Using CAIT, no anesthesiologist generated pressures above 1,034 mm Hg, while 29 of 30 produced pressures above this limit at some time using the syringe feel method. The mean pressure using CAIT was lower (636 +/- 71 vs. 1378 +/- 194 mm Hg, P = .025), and the syringe feel method resulted in higher peak pressures (1,875 +/- 206 vs. 715 +/- 104 mm Hg, P = .000). CONCLUSIONS: This study demonstrated that CAIT can effectively keep injection pressures under 1,034 mm Hg in this in vitro model. Animal and clinical studies will be needed to determine whether CAIT will allow objective, real-time pressure monitoring. If high pressure injections are proven to contribute to nerve injury in humans, this technique may have the potential to improve the safety of peripheral nerve blocks.
BACKGROUND AND OBJECTIVES: High injection pressures have been associated with intraneural injection and persistent neurological injury in animals. Our objective was to test whether a reported simple compressed air injection technique (CAIT) would limit the generation of injection pressures to below a suggested 1,034 mm Hg limit in an in vitro model. METHODS: After ethics board approval, 30 consenting anesthesiologists injected saline into a semiclosed system. Injection pressures using 30 mL syringes connected to a 22 gauge needle and containing 20 mL of saline were measured for 60 seconds using: (1) a typical "syringe feel" method, and (2) CAIT, thereby drawing 10 mL of air above the saline and compressing this to 5 mL prior to and during injections. All anesthesiologists performed the syringe feel method before introduction and demonstration of CAIT. RESULTS: Using CAIT, no anesthesiologist generated pressures above 1,034 mm Hg, while 29 of 30 produced pressures above this limit at some time using the syringe feel method. The mean pressure using CAIT was lower (636 +/- 71 vs. 1378 +/- 194 mm Hg, P = .025), and the syringe feel method resulted in higher peak pressures (1,875 +/- 206 vs. 715 +/- 104 mm Hg, P = .000). CONCLUSIONS: This study demonstrated that CAIT can effectively keep injection pressures under 1,034 mm Hg in this in vitro model. Animal and clinical studies will be needed to determine whether CAIT will allow objective, real-time pressure monitoring. If high pressure injections are proven to contribute to nerve injury in humans, this technique may have the potential to improve the safety of peripheral nerve blocks.
Authors: Joseph M Neal; J C Gerancher; James R Hebl; Brian M Ilfeld; Colin J L McCartney; Carlo D Franco; Quinn H Hogan Journal: Reg Anesth Pain Med Date: 2009 Mar-Apr Impact factor: 6.288
Authors: Joseph M Neal; Christopher M Bernards; Admir Hadzic; James R Hebl; Quinn H Hogan; Terese T Horlocker; Lorri A Lee; James P Rathmell; Eric J Sorenson; Santhanam Suresh; Denise J Wedel Journal: Reg Anesth Pain Med Date: 2008 Sep-Oct Impact factor: 6.288