0000000000309083
AUTHOR
André P. Boezaart
ESRA19-0618 Vulnerability of different nerves to intrafascicular injection with different needle bevel types and needle angles: a mathematical model
Background and aims Intrafascicular injection of a local anesthetic, its toxicity, and direct needle trauma to nerve tissue are generally considered the primary reasons for nerve injury after intraneural injection. We hypothesize that the only way that the local anesthetic can enter the fascicle is if at least 80% of the distal needle orifice is inside the fascicle. the aim of this study was to calculate the theoretical vulnerability of nerve fascicles given their actual sizes and that of different needle openings. Methods We superimposed microscopic images of two routinely used nerve block needles (a 22-G, 15 ‘StimuplexOD’ needleand a 22-G, 30 ‘StimuplexOUltra 360O’ needle) over microscopi…
Case series of fluoroscopic findings and 3D reconstruction of human spinal MRIs of the space of Okada.
Objective To better understand the unexpected spread of contrast medium observed by conventional fluoroscopic X-ray images during standard neuraxial techniques used in the treatment of pain. The support of 3D reconstruction of MRI images of structures within the lumbar spine was used to better understand the space of Okada. Methods Lumbar facet joint and epidural corticosteroid injections in five patients under fluoroscopic guidance with loss of resistance to air or saline to identify the facet joints or epidural space. Next, in a retrospective study, the authors examined the retrodural space of Okada and the neighboring tissues with 3D reconstruction of spinal MRIs of seven patients withou…
Vulnerability of different nerves to intrafascicular injection by different needle types and at different approach angles: a mathematical model
Background and objectivesWe assume that intrafascicular spread of a solution can only occur if a large enough portion of the distal needle orifice is placed inside the fascicle. Our aim is to present and evaluate a mathematical model that can calculate the theoretical vulnerability of fascicles, analyzing the degree of occupancy of the needle orifice in fascicular tissue by performing simulations of multiple positions that a needle orifice can take inside a cross-sectional nerve area.MethodsWe superimposed microscopic images of two routinely used nerve block needles (22-gauge, 15° needle and 22-gauge, 30° needle) over the microscopic images of cross-sections of four nerve types photographed…