You are here

Article Text

Article menu
Download PDFPDF
ORIGINAL ARTICLES
Structural Injury to the Human Sciatic Nerve After Intraneural Needle Insertion
  1. Xavier Sala-Blanch, MD*,
  2. Teresa Ribalta, MD, PhD†,
  3. Eva Rivas, MD‡,
  4. Ana Carrera, MD, PhD§,
  5. Albert Gaspa, MD†,
  6. Miguel A. Reina, MD, PhD∥ and
  7. Admir Hadzic, MD, PhD
  1. From the Departments of *Anesthesiology,
  2. †Pathology, and
  3. ‡Anesthesiology, Hospital Clínic of Barcelona,
  4. §Department of Human Anatomy, School of Medicine, University of Barcelona, and
  5. ∥Department of Anesthesiology, Clínica Montepríncipe, Madrid, Spain; and
  6. Department of Anesthesia, St Luke's-Roosevelt Hospital Center, New York, NY.
  1. Address correspondence to: Admir Hadzic, MD, PhD, Department of Anesthesia, St Luke's-Roosevelt Hospital Center, 1111 Amsterdam Ave, New York, NY 10025 (e-mail: admir{at}nysora.com).

Abstract

Background: Recent clinical reports suggest that intraneural needle placement may not always lead to neurologic injury. To explain the absence of neurologic complications in these reports, we studied the risk and extent of nerve injury after intentional needle-nerve placement in a cryopreserved human sciatic nerve.

Methods: The sciatic nerve was dissected from a cryopreserved cadaver through partial exposure. Needles were inserted through the nerve, using blunt-tip (30 degrees beveled) (group A) and sharp-tip (15 degrees beveled) (group D) needles. Five needle insertions were made for each needle type. Subsequently, transverse nerve sections at 10 needle trajectories were processed. Nerve samples were stained with hematoxylin-eosin, Masson trichromic, and immunohistochemical stains. In each section, the following variables were quantified: total number of fascicles and vessels in the immediate vicinity of the needle trajectories and the number of injured fascicles and vessels.

Results: A total of 520 fascicles were quantified, of which 134 were in contact with the needle trajectories. The numbers of fascicles and vessels per section were 65 ± 8 and 14 ± 7, respectively. A mean of 16 ± 5 fascicles were found in contact with the needle trajectory (group A: 17± 3, group D: 15 ± 6). Of these, 4 fascicles (3.2%) and 1 intraneural vessel were found damaged in group D. No fascicular or vascular injuries were found in group A.

Conclusions: Our findings suggest that intraneural needle insertion may more commonly result in interfascicular rather than intrafascicular needle placement.

https://doi.org/10.1097/AAP.0b013e31819a2795

Statistics from Altmetric.com

    Request Permissions

    If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

    Footnotes

    • Institution to which work is attributed: University of Barcelona, Spain.

    • This work was supported by the University of Barcelona, Spain.