Intraneural ?!
Posted by Thomas on November 24, 2007 under ISURA 2009 | 
Read the First Comment
This letter to the editor was rejected “as firmly as possible”, we see some necessity for public access …..
Ultrasound (US) guided Regional Anesthesia (RA) needs thoroughness but not adventurous experiments
RE: Bigeleisen: Anesthesiology 2006; 105: 779-83
T.Grau; B. Moriggl
Thomas Grau MD PhD Department of Anaesthesiology, Intensive Care, Palliative Care and Pain Medicine, BG University Hospital Bergmannsheil Bochum, Bürkle de la Camp Platz 1, 44789 Bochum Germany e-mail : grau@anaesthesia.de
Bernhard Moriggl MD Prof. Department for Anatomy, Histology and Embryology Medical University Innsbruck Müllerstrasse 59 A-6020 Innsbruck
Bigeleisen conducted his study because he detected accidental puncturing and consecutive LA application into nerves in reviewing his video archives of 50 “US-guided axillary blocks”. Basically, he performed axillary nerve blocks in 26 patients with application of 2-3 ml of LA intraneural. This was followed by application of another 2-3 ml around the nerve.
Among the clinical physicians practicing and teaching US-guided procedures in RA (not only peripheral nerve blocks), there is absolutely no “debate about what images mean”! Moreover, there is no consistency between a local anesthetic ring around a nerve and a “tissue plane” (whatever this might be). We argue that such description is simply embarrassing. The same applies to what we read with complete bewilderment in the whole second paragraph of the introduction. There is an unmasking description of the approach to the peripheral nerve as practiced by the author.
There is no beating about the bush: If anesthetists doing US-guided procedures really puncture “one or more nerves” during an axillary blockade “in each patient” – presumably inadvertently! – we may well do withoutcolleagues having comparable “experience”! That patients “did not experience any known sequelae” does by no means justify performance of this study. We see no necessity to “determine the incidence of needle entry into the nerve”, and to demonstrate what a nerve looks like “if LA is injected into a nerve”. Such a processing has nothing to do with an US guided block concept.