More steps can be taken to decrease risk even more
Can the risk of neurologic injury due to regional anesthesia go from very low to extremely low? That was the question on the minds of many anesthesiologists at this year’s International Symposium of Ultrasound for Regional Anesthesia, Pain Medicine and Perioperative Applications in Toronto, Canada.
Already, the risk of neurologic injury is low, but some say there are even more steps anesthesiologists can take to reduce the risk even lower.
“What we do is very safe, but this allows us to spend a lot of time talking about the optimal way to make things even safer,” said Kyle Kirkham, MD, FRCPC, staff anesthesiologist at Toronto Western Hospital, University Health Network and assistant professor to the Department of Anesthesia at the University of Toronto, Ontario, Canada. “Can we step back and find an approach that doesn’t require the needle to be in contact with the nerve at all?”
Research based on the topic of increasing proximity to the nerve without causing injury has been done in the past, but now experts are calling on more alternative approaches to be looked at, such as maintaining a distance from the nerve while still delivering a sufficient diffusion of anesthetic.
Studies concerning current flow and twitch have shed some light on avoiding nerve damage, but nothing concrete has been set forth yet.
“We have discovered that a lot of studies have shown you can be touching the nerve and have high current and not get a twitch,” said Paul McHardy, MD, FRCPC, an anesthesiologist at Sunnybrook Health Sciences Centre in Toronto. “At the same time, you can be outside the nerve, have low current and have a twitch. The architectural structure of the nerves behaves differently in terms of risk.”
Using pressure as a measurement was thought to be a reliable way to minimize the risk of neurologic injury. However, one animal study showed that high injection pressures may suggest intraneural needle placement and result in persistent neurologic deficits, which led the authors to recommend against excessive injection pressure.
One anesthesiologist, Xavier Sala-Blanch, MD, director of the Orthopedic Anesthesia Section at the University of Barcelona, Spain, looked at retrospective research which determined ultrasound guidance can decrease the risk for local anesthetic systemic toxicity after a peripheral nerve blockade.
“It is important that we try to reduce the percentage of injury,” said Dr. Sala-Blanch. “Ultrasound helps us to do this.”
To read more on the topic of reducing the risks of regional anesthesia techniques, click here: Techniques Can Push Regional Anesthesia Risks Still Lower.
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