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High Opening Injection Pressure Is Associated With Needle-Nerve and Needle-Fascia Contact During Femoral Nerve Block
  1. Jeff Gadsden, MD, FRCPC, FANZCA*,
  2. Malikah Latmore, MD,
  3. D. Matt Levine, MB ChB, FANZCA and
  4. Allegra Robinson, RN§
  1. *Department of Anesthesiology, Duke University, Durham, NC
  2. Department of Anesthesiology, St Luke’s–Roosevelt Hospital, New York, NY
  3. Wellington Regional Hospital, Wellington, New Zealand
  4. §New York University, New York, NY
  1. Address correspondence to: Jeff Gadsden, MD, FRCPC, FANZCA, Department of Anesthesiology, Duke University Medical Center, DUMC 3094 MS19, Durham, NC 27710 (e-mail: jeff.gadsden{at}


Background and Objectives High opening injection pressures (OIPs) have been shown to predict sustained needle tip contact with the roots of the brachial plexus. Such roots have a uniquely high ratio of fascicular versus connective tissue. It is unknown if this relationship is preserved during multifascicular nerve blockade. We hypothesized that OIP can predict needle-nerve contact during femoral nerve block, as well as detect needle contact with the fascia iliaca.

Methods Twenty adults scheduled for femoral block were recruited. Using ultrasound, a 22-gauge needle was sequentially placed in 4 locations: indenting the fascia iliaca, advanced through the fascia iliaca while lateral to the nerve, slightly indenting the femoral nerve, and withdrawn from the nerve 1 mm. At each location, the OIP required to initiate an injection of 1 mL D5W (5% dextrose in water) at 10 mL/min was recorded. Blinded investigators performed evaluations and aborted injections when an OIP of 15 psi was reached.

Results Opening injection pressure was 15 psi or greater for 90% and 100% of cases when the needle indented the femoral nerve and fascia iliaca, respectively. Opening injection pressure was less than 15 psi for all 20 patients when the needle was withdrawn 1 mm from the nerve as well as at the subfascial position (McNemar χ2 P < 0.001).

Conclusions Opening injection pressure greater than 15 psi was associated with a block needle tip position slightly indenting the epineurium of the femoral nerve (90%) and the fascia iliaca (100%). Needle tip positions not indenting these structures were associated with OIP of less than 15 psi (100%).

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  • Sources of funding: Departmental.

    The abstract of this study was accepted for presentation at the 40th Annual Regional Anesthesia and Acute Pain Medicine Meeting of the American Society of Regional Anesthesia and Pain Medicine, Las Vegas, NV, May 14 to 16, 2015.

    The authors declare no conflict of interest.