Article Text
PDF
Abstract
Postmortem histology and in vivo, animal-based ultra-high-definition microultrasound demonstrate a complex array of non-communicating adipose tissue compartments enclosed by fascia. Classic nerve block mechanisms and histology do not consider this tissue. Injected local anesthetic agents can occupy any of these adipose compartments, which may explain the significant differences in outcomes such as success rates, onset time, block density, duration of nerve block, and secondary continuous block failure. Furthermore, these adipose tissue compartments may influence injection pressures, making conclusions about needle tip location unreliable. This educational review will explain the neural anatomy associated with these fatty compartments in detail and suggest how they may affect block outcomes.
- Anesthesia, Conduction
- Anesthesia, Local
- Methods
- EDUCATION
- TECHNOLOGY
Data availability statement
No data are available.
Statistics from Altmetric.com
Data availability statement
No data are available.
Footnotes
X @gamcleod2, @aboezaart1
Contributors GAM: conceptualization, investigation, writing–original draft. AS: investigation, writing–reviewing and editing, AB: investigation, writing–reviewing and editing, XS-B: investigation, writing–reviewing and editing, MAR: conceptualization, investigation, writing–original draft. GAM, corresponding author, serves as guarantor. ChatGPT, Grammarly, and other generative AI technologies were periodically used to create this manuscript, specifically for text editing and acquiring appropriate references.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests AB invented perineural catheters (StimuCath, TheraCath, and UltraCath) for which he received royalties from Arrow International and later, after 2007, from TeleFlex Medical for their sales for the duration of the patents, which have now expired. All other authors declare no conflict of interest.
Provenance and peer review Not commissioned; externally peer reviewed.
Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.