Intraneural injection of local anesthetics during ultrasound-guided peripheral nerve block may lead to nerve injury.

摘要

To the Editor:-I read with interest the article by Bigeleisen. In this article, the author presented a prospective study of ultrasound-guided axillary blocks and determined the incidence of nerve puncture, intraneural injection of local anesthetics, and transient or permanent nerve injuries. After reading this well-written article it occurred to me that there are some points that may add to discussion. Damage may be caused to peripheral nerves after regional anesthesia techniques by mechanical chemical, or ischemic injuries, which may occur alone or in combination. Iohom et al, reported that intraneural injection of ropivacaine in rat sciatic nerve, in a concentration routinely used in clinical practice, caused no deleterious effect on motor function. Hadzic et at? reported varying degrees of damage to the neural architecture after high-pressure injection of local anesthetic in dog sciatic nerve. This damage ranged from mechanical disruption and delamination to fragmentation of the myelin sheath and marked cellular infiltration. They also reported severe and persistent motor deficits.