Identification of spread after deliberate intraneural injection in five mammalian species.

IF 5.1 2区 医学 Q1 ANESTHESIOLOGY Regional Anesthesia and Pain Medicine Pub Date : 2024-09-02 DOI:10.1136/rapm-2023-104820
Anna Server, Andre P Boezaart, Marcos Perez-Carrasco, Marielle Esteves-Coelho, Franciso Laredo, Miguel A Reina
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Abstract

Introduction: This research endeavors to investigate the phenomenon of intraneural spread across distinct locations: subcircumneurium, extrafascicular intraneural, intrafascicular intraneural, and intraperineurium after deliberate intraneural injections across five mammalian species. The study also aims to propose determinants influencing this spread. Furthermore, the investigation strives to ascertain the optimal animal species and needle configuration for extrapolating intraneural injection outcomes to human contexts.

Methods: This study examined 60 sciatic nerves from 30 fresh and untreated cadavers of rats, rabbits, dogs, pigs, and sheep. The specimens were organized into five groups, each comprising an equal number of nerves. Histological assessments were performed on 30 nerves, involving fascicle metrics. The remaining 30 nerves underwent intentional intraneural injections, facilitated by 19G and 23G needles under ultrasound and direct visualization guidance.Heparinized erythrocytes combined with a methylene blue solution were used as a marker to analyze the extent and patterns of intraneural spread. Needle orifice measurements were obtained, and these data were overlaid onto images of both nerves and needles. This enabled a comparative evaluation of sizes and an assessment of marker diffusion.

Results: The findings indicated that sciatic nerves in rats, rabbits, and dogs were oligofascicular, characterized by larger fascicles, whereas pigs and sheep exhibited polyfascicular nerves comprised of numerous smaller fascicles. Fascicular diameters were variable across species, with dogs presenting the largest measurements. While intraneural spread was observed and documented, intrafascicular marker spreading was rare, occurring only in one rabbit specimen. Needle orifice attributes were scrutinized and visually depicted.

Conclusions: Despite the formidable challenges associated with the practical realization of intrafascicular injection, the utilization of animal models possessing monofascicular or oligofascicular nerves, such as rats, rabbits, and dogs, in conjunction with needles featuring aperture dimensions surpassing those of the fascicles, likely contributes to the compromised reliability of investigations into intraneural injection outcomes.

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在五种哺乳动物中鉴定故意硬膜内注射后的扩散。
导言:本研究旨在调查五种哺乳动物在故意进行硬膜内注射后,硬膜内扩散到不同位置的现象,这些位置分别是:圆周下、筋膜外、筋膜内和会厌内。研究还旨在提出影响这种扩散的决定因素。此外,该研究还致力于确定最佳的动物物种和针头配置,以便将硬膜内注射的结果推断到人体环境中:本研究检查了来自 30 具新鲜和未经处理的尸体的 60 根坐骨神经,包括大鼠、兔子、狗、猪和羊。标本分为五组,每组神经数量相等。对 30 条神经进行了组织学评估,涉及神经束的度量。肝素化红细胞与亚甲蓝溶液结合作为标记物,用于分析硬膜内扩散的范围和模式。获得针孔测量值,并将这些数据叠加到神经和针头的图像上。这样就能对尺寸进行比较评估,并对标记物的扩散进行评估:结果:研究结果表明,大鼠、兔子和狗的坐骨神经呈少筋束状,以较大的筋束为特征,而猪和羊的坐骨神经呈多筋束状,由许多较小的筋束组成。不同物种的筋束直径各不相同,狗的筋束直径最大。虽然可以观察和记录到神经束内扩散,但筋膜内标记物扩散却很罕见,仅在一个兔子标本中出现过。对针孔属性进行了仔细检查和视觉描述:结论:尽管实际实现筋膜内注射存在巨大挑战,但利用大鼠、兔子和狗等拥有单筋膜或少筋膜神经的动物模型,再加上针孔尺寸超过筋膜的特点,很可能会导致硬膜内注射结果研究的可靠性大打折扣。
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来源期刊
CiteScore
8.50
自引率
11.80%
发文量
175
审稿时长
6-12 weeks
期刊介绍: Regional Anesthesia & Pain Medicine, the official publication of the American Society of Regional Anesthesia and Pain Medicine (ASRA), is a monthly journal that publishes peer-reviewed scientific and clinical studies to advance the understanding and clinical application of regional techniques for surgical anesthesia and postoperative analgesia. Coverage includes intraoperative regional techniques, perioperative pain, chronic pain, obstetric anesthesia, pediatric anesthesia, outcome studies, and complications. Published for over thirty years, this respected journal also serves as the official publication of the European Society of Regional Anaesthesia and Pain Therapy (ESRA), the Asian and Oceanic Society of Regional Anesthesia (AOSRA), the Latin American Society of Regional Anesthesia (LASRA), the African Society for Regional Anesthesia (AFSRA), and the Academy of Regional Anaesthesia of India (AORA).
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