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Injection pressure limiter


Avoiding nerve damage during peripheral nerve blocks

Ultrasound-guided localisation of peripheral nerves provide crucial benefits in regional anaesthesia.1) Nonetheless, it is clear that this does not reduce the incidence of permanent nerve damage.2) Even in combination with nerve stimulation, intrafascicular injections cannot be ruled out.1)3)4)5) With the automatic injection pressure limiter NerveGuard, PAJUNK® addresses the preventive position control to avert following damages.

Causes of the development of nerve damage


Intrafascicular injections
If the pressure during intrafascicular injections exceeds a critical threshold of 15 psi, such injections may demonstrably lead to severe long-term neurological complications.6)7)8) In the case of several hours lasting intrafascicular injections at high pressure, the microvascular blood supply of the nerve is severely restricted, which can lead to degeneration of nerve structures.7)12)

  • Limiting the injection pressure to 15 psi avoids nerve damage.


Cannula-nerve contact
Direct cannula-nerve contact can also lead to damage of the neural structures with subsequent transient or permanent neurological impairment.10)11) Localisation control using ultrasound and/or nerve stimulation may not in all cases reliably indicate direct cannula-nerve contact.10) Avoiding direct cannula-nerve contact minimises the risk of damage to the nerve wall.11)

  • A reliable indicator of direct cannula-nerve contact is an opening pressure of ≥ 15 psi.






Cannula-fascia contact
Injections administered in the wrong tissue layers can also cause anaesthesia failures. An opening pressure of ≥ 15 psi may indicate occlusion of the tip of the cannula due to fascia in front of it.9)

  • To prevent injections in the wrong tissue layers close to the nerve, the critical threshold is an opening pressure of 15 psi.






NerveGuard offers additional support in the localisation of the cannula tip and prevents nerve damage, together with the automatic pressure limitation.



1) Choquet, Capdevila, Ultrasound-guided nerve blocks …, 2012 May; 114(5): 929–930

2) Neil et al., The Second American Society of Regional Anesthesia …, 2016 March–April; 41(2): 183

3) Robards et al., Intraneural injection with low-current stimulation …, 2009 Aug; 109(2): 673–677

4) Vassiliou et al., Risk evaluation for needle-nerve contact related …, 2016 Mar; 60(3): 400–406

5) Sites et al., Characterizing novice behavior associated with …, 2007 Mar–Apr; 32(2): 107–115

6) Kapur et al., Neurologic and histologic outcome …, 2007 Jan; 51(1): 101–107

7) Hadzic et al., Combination of intraneural injection …, 2004 September–October; 29(5): 417–423

8) Hasanbegovic et al., Effects of intraneural and perineural injection …, 2013; 3(3): 248

9) Gadsen et al., High Opening Injection Pressure is Associated With Needle-Nerve …, 2016 Jan–Feb; 41(1): 50–55

10) Gadsden et al., Opening injection pressure consistently detects needle–nerve contact …, 2014 May; 120(5): 1246–1253

11) Steinfeldt et al., Histological consequences of needle-nerve contact following nerve stimulation …, 2011; Article ID 591851: 0–9

12) Lundborg et al., Nerve compression injury and increased endoneurial fluid pressure …, 1983 Dec; 46(12): 1119–1124

 
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