학술논문
Mechanics of anesthetic needle penetration into human sciatic nerve.
Document Type
Academic Journal
Author
Pichamuthu JE; Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, United States; McGowan Institute for Regenerative Medicine, Pittsburgh, PA, United States; Center for Vascular Remodeling and Regeneration, University of Pittsburgh, Pittsburgh, PA, United States.; Maiti S; Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, United States.; Gan MG; Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, United States.; Verdecchia NM; Department of Anesthesiology, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States.; Orebaugh SL; Department of Anesthesiology, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States.; Vorp DA; Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, United States; McGowan Institute for Regenerative Medicine, Pittsburgh, PA, United States; Center for Vascular Remodeling and Regeneration, University of Pittsburgh, Pittsburgh, PA, United States; Departments of Cardiothoracic Surgery, Surgery, and Chemical & Petroleum Engineering, University of Pittsburgh, Pittsburgh, PA, United States; Clinical & Translational Sciences Institute, University of Pittsburgh, Pittsburgh, PA, United States. Electronic address: vorp@pitt.edu.
Source
Publisher: Elsevier Science Country of Publication: United States NLM ID: 0157375 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1873-2380 (Electronic) Linking ISSN: 00219290 NLM ISO Abbreviation: J Biomech Subsets: MEDLINE
Subject
Language
English
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.
(Copyright © 2018 Elsevier Ltd. All rights reserved.)
(Copyright © 2018 Elsevier Ltd. All rights reserved.)