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Optical Detection of the Brachial Plexus for Peripheral Nerve Blocks: An In Vivo Swine Study
  1. Marcus Brynolf, MD*,
  2. Micha Sommer, MD, PhD,
  3. Adrien E. Desjardins, PhD,
  4. Marjolein van der Voort, PhD,
  5. Stefan Roggeveen, Ir,
  6. Walter Bierhoff, PhD,
  7. Benno H.W. Hendriks, PhD,
  8. James P. Rathmell, MD§,
  9. Alfons G.H. Kessels, MD, Ir,
  10. Michael Söderman, MD, PhD and
  11. Björn Holmström, MD, PhD#,**
  1. From the *Department of Anesthesiology and Intensive Care, Karolinska University Hospital, Huddinge, Stockholm, Sweden;
  2. Department of Anesthesiology, Academic Hospital of Maastricht, Maastricht, The Netherlands;
  3. Philips Research, Eindhoven, The Netherlands;
  4. §Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital/Harvard Medical School, Boston, MA;
  5. Department of Clinical Epidemiology & Medical Technology Assessment, Academic Hospital of Maastricht, Maastricht, The Netherlands;
  6. Department of Clinical Neuroscience, Karolinska Institutet, and Department of Neuroradiology, Karolinska University Hospital, Solna, Stockholm, Sweden;
  7. #Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden; and
  8. **Department of Anesthesiology and Intensive Care, Karolinska University Hospital, Huddinge, Sweden.
  1. Address correspondence to: Björn Holmström, MD, PhD, Department of Anesthesiology and Intensive Care, B31, Karolinska University Hospital, Huddinge, SE-141 86 Stockholm, Sweden (e-mail: bjorn.holmstrom{at}


Background and Objectives: Accurate identification of nerves is critical to ensure safe and effective delivery of regional anesthesia during peripheral nerve blocks. Nerve stimulation is commonly used, but it is not perfect. Even when nerve stimulation is performed in conjunction with ultrasound guidance, determining when the needle tip is at the nerve target region can be challenging. In this in vivo pilot study, we investigated whether close proximity to the brachial plexus and penetration of the axillary artery can be identified with optical reflectance spectroscopy, using a custom needle stylet with integrated optical fibers.

Methods: Ultrasound-guided insertions to place the needle tip near the brachial plexus at the axillary level were performed at multiple locations in 2 swine, with the stylet positioned in the cannula of a 20-gauge stimulation needle. During each insertion, optical reflectance spectra were acquired with the needle tip in skeletal muscle, at the surface of muscle fascia, and at the nerve target region; confirmation of the final needle position was provided by nerve stimulation. In addition, an insertion to the lumen of the axillary artery was performed in a third swine. Differences in the spectra were quantified with lipid and hemoglobin parameters that provide contrast for optical absorption by the respective chromophores.

Results: The transition of the needle tip from skeletal muscle to the nerve target region was associated with higher lipid parameter values (P < 0.001) and lower hemoglobin parameter values (P < 0.001). The transition of the needle tip from muscle fascia to the nerve target region was associated with higher lipid parameter values (P = 0.001). Intraluminal access of the axillary artery was associated with an elevated hemoglobin parameter.

Conclusions: Spectroscopic information obtained with the optical needle is distinct from nerve stimulation and complementary to ultrasound imaging, and it could potentially allow for reliable identification of the injection site during peripheral nerve blocks.

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  • This study was supported by Philips Research, Eindhoven, The Netherlands.

  • None of the authors who are affiliated with clinical institutions (M.B., M.S., J.R., A.K., M.S., and B.H.) have financial interests in the subject matter, materials, or equipment or with any competing materials. These authors received no payment of any kind for their participation in this research project, nor did their institutions receive payment for anything beyond the direct costs of performing this research project at Karolinska University Hospital. Their interests are purely at a scientific level.