Mechanics of anesthetic needle penetration into human sciatic nerve |
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| Institution: | 1. Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, United States;2. McGowan Institute for Regenerative Medicine, Pittsburgh, PA, United States;3. Center for Vascular Remodeling and Regeneration, University of Pittsburgh, Pittsburgh, PA, United States;4. Department of Anesthesiology, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States;5. Departments of Cardiothoracic Surgery, Surgery, and Chemical & Petroleum Engineering, University of Pittsburgh, Pittsburgh, PA, United States;6. Clinical & Translational Sciences Institute, University of Pittsburgh, Pittsburgh, PA, United States;1. Centre for Medical Radiation Physics, University of Wollongong, Australia;2. St George Cancer Care Centre, St George Hospital, Kogarah, New South Wales, Australia;3. Advanced Computer System Pty Ltd, Rome, Italy;4. Institute of Experimental and Applied Physics, Czech Technical University of Prague, Prague, Czech Republic;1. Department of Engineering, Faculty of Science and Technology, Aarhus University, Finlandsgade 22, 8200 Aarhus N, Denmark;2. Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark;3. Department of Clinical Medicine, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark;1. Departamento de Medicina y Cirugía Animal, Universidad de Murcia, Murcia 30100, Spain;2. Departamento de Anatomía y Anatomía Patológica Comparadas, Universidad de Murcia, Murcia 30100, Spain;3. Departamento de Biología Celular e Histología, Universidad de Murcia, Murcia 30100, Spain |
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| Abstract: | Nerve blocks are frequently performed by anesthesiologists to control pain. For sciatic nerve blocks, the optimal placement of the needle tip between its paraneural sheath and epineurial covering is challenging, even under ultrasound guidance, and frequently results in nerve puncture. We performed needle penetration tests on cadaveric isolated paraneural sheath (IPS), isolated nerve (IN), and the nerve with overlying paraneural sheath (NPS), and quantified puncture force requirement and fracture toughness of these specimens to assess their role in determining the clinical risk of nerve puncture. We found that puncture force (123 ± 17 mN) and fracture toughness (45.48 ± 9.72 J m?2) of IPS was significantly lower than those for NPS (1440 ± 161 mN and 1317.46 ± 212.45 Jm?2, respectively), suggesting that it is not possible to push the tip of the block needle through the paraneural sheath only, without pushing it into the nerve directly, when the sheath is lying directly over the nerve. Results of this study provide a physical basis for tangential placement of the needle as the ideal situation for local anesthetic deposition, as it allows for the penetration of the sheath along the edge of the nerve without entering the epineurium. |
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| Keywords: | Sciatic nerve Nerve block Needle puncture force Fracture toughness |
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