Intrafascicular Injection: Can AI, Ultrasound, Pressure Monitoring, and Echogenic Needles Prevent It?
Vol 6 | Issue 1 | January-June 2025 | Page 08-14 | Divesh Arora
DOI: https://doi.org/10.13107/ijra.2025.v06.i01.114
Open Access License: CC BY-NC 4.0
Copyright Statement: Copyright © 2025; The Author(s).
Submitted: 28-02-2025; Reviewed: 22-03-2025; Accepted: 25-05-2025; Published: 10-06-2025
Authors: Divesh Arora [1]
[1] Department of Anaesthesia & OT Services, Asian Hospital, Faridabad, Haryana, India.
Address of Correspondence
Dr. Divesh Arora,
Director & HOD, Department of Anaesthesia & OT Services, Asian Hospital, Faridabad, Haryana, India.
Email ID: drdivesh@gmail.com
Abstract
Intrafascicular injection represents one of the most serious complications in regional anaesthesia, potentially resulting in irreversible neurological injury. Despite the advances in ultrasound-guided techniques, inadvertent intraneural and intrafascicular injections still occur. This review synthesizes the current understanding of nerve microanatomy, mechanisms of nerve injury, and the diagnostic and preventive strategies aimed at avoiding this catastrophic event. It highlights the role of ultrasound technology, echogenic needle innovations, injection pressure monitoring, neurostimulation, and emerging applications of artificial intelligence in enhancing procedural safety. The integration of these multimodal safety tools can significantly reduce operator dependency and improve real-time feedback during nerve block procedures. With continued technological refinement, structured training, and incorporation of AI-assisted imaging and robotics, the risk of intrafascicular injection can be minimized, thereby improving patient safety and outcomes in regional anaesthesia.
Keywords: Intrafascicular injection, Regional anaesthesia safety, Ultrasound guidance, Echogenic needles, Pressure monitoring, Artificial intelligence.
References
1. Bais K, Guirguis F, Guirguis M. Nerve injury following regional nerve block: a literature review of its etiologies, risk factors, and prevention. Current Pain and Headache Reports. 2024 Sep;28(9):863-8.
2. Sala-Blanch X, Boezaart AP, McLeod GA, Reina MA. Risk of intrafascicular spread after deliberate ex vivo intraneural injections of brachial plexus nerve roots. British journal of anaesthesia. 2025 Feb 1;134(2):545-56.
3. Thomas PK. The connective tissue of peripheral nerve: an electron microscope study. Journal of anatomy. 1963 Jan;97(Pt 1):35.
4. McLeod GA, Sadler A, Boezaart A, Sala-Blanch X, Reina MA. Peripheral nerve microanatomy: new insights into possible mechanisms for block success. Regional Anesthesia & Pain Medicine. 2024 Sep 26.
5. Boezaart AP. The sweet spot of the nerve: is the “paraneural sheath” named correctly, and does it matter?. Regional Anesthesia and Pain Medicine. 2014 Nov 1;39(6):557-8.
6. Reina MA, Boezaart AP, Tubbs RS, Zasimovich Y, Fernández‐Domínguez M, Fernández P, Sala‐Blanch X. Another (internal) epineurium: beyond the anatomical barriers of nerves. Clinical Anatomy. 2020 Mar;33(2):199-206.
7. Hewson DW, Bedforth NM, Hardman JG. Peripheral nerve injury arising in anaesthesia practice. Anaesthesia. 2018 Jan;73:51-60.
8. Brull R, Hadzic A, Reina MA, Barrington MJ. Pathophysiology and etiology of nerve injury following peripheral nerve blockade. Regional Anesthesia & Pain Medicine. 2015 Sep 1;40(5):479-90.
9. Lundborg G, Rydevik B. Effects of stretching the tibial nerve of the rabbit: a preliminary study of the intraneural circulation and the barrier function of the perineurium. The Journal of Bone & Joint Surgery British Volume. 1973 May 1;55(2):390-401.
10. Kalichman MW. Physiologic mechanisms by which local anesthetics may cause injury to nerve and spinal cord. Regional Anesthesia and Pain Medicine. 1993 Nov 1;18(Suppl 6):448-52.
11. Butterworth JF, Strichartz GR. Molecular mechanisms of local anesthesia: a review. Anesthesiology. 1990 Apr 1;72(4):711-34.
12. Radwan IA, Saito S, Goto F. The neurotoxicity of local anesthetics on growing neurons: a comparative study of lidocaine, bupivacaine, mepivacaine, and ropivacaine. Anesthesia & Analgesia. 2002 Feb 1;94(2):319-24.
13. Mackinnon SE, Hudson AR, Gentili F, Kline DG, RT H. Peripheral nerve injection injury with steroid agents. Plastic and reconstructive surgery. 1982 Mar 1;69(3):482-9.
14. Gentili F, Hudson AR, Hunter D. Clinical and experimental aspects of injection injuries of peripheral nerves. Canadian Journal of Neurological Sciences. 1980 May;7(2):143-51.
15. BELL MA. A descriptive study of the blood vessels of the sciatic nerve in the rat, man and other mammals. Brain. 1984 Sep 1;107(3):871-98.
16. Myers RR, Heckman HM, Rodriguez M. Reduced hyperalgesia in nerve-injured WLD mice: relationship to nerve fiber phagocytosis, axonal degeneration, and regeneration in normal mice. Experimental neurology. 1996 Sep 1;141(1):94-101.
17. Steinfeldt T, Graf J, Schneider J, Nimphius W, Weihe E, Borgeat A, Wulf H, Wiesmann T. Histological consequences of needle‐nerve contact following nerve stimulation in a pig model. Anesthesiology research and practice. 2011;2011(1):591851.
18. Welch MB, Brummett CM, Welch TD, Tremper KK, Shanks AM, Guglani P, Mashour GA. Perioperative peripheral nerve injuries: a retrospective study of 380,680 cases during a 10-year period at a single institution. Anesthesiology. 2009 Sep 1;111(3):490-7.
19. Cappelleri G, Cedrati VL, Fedele LL, Gemma M, Camici L, Loiero M, Gallazzi MB, Cornaggia G. Effects of the intraneural and subparaneural ultrasound-guided popliteal sciatic nerve block: a prospective, randomized, double-blind clinical and electrophysiological comparison. Regional Anesthesia & Pain Medicine. 2016 Jul 1;41(4):430-7.
20. Sala-Blanch X, Vandepitte C, Laur JJ, Horan P, Xu D, Reina MA, Karmakar MK, Clark TB, Hadzic A. A practical review of perineural versus intraneural injections: a call for standard nomenclature. International Anesthesiology Clinics. 2011 Oct 1;49(4):1-2.
21. Krediet AC, Moayeri N, Bleys RL, Groen GJ. Intraneural or extraneural: diagnostic accuracy of ultrasound assessment for localizing low-volume injection. Regional Anesthesia & Pain Medicine. 2014 Sep 1;39(5):409-13.
22. Moayeri N, Krediet AC, Welleweerd JC, Bleys RL, Groen GJ. Early ultrasonographic detection of low-volume intraneural injection. British journal of anaesthesia. 2012 Sep 1;109(3):432-8.
23. Neal JM, Barrington MJ, Brull R, Hadzic A, Hebl JR, Horlocker TT, Huntoon MA, Kopp SL, Rathmell JP, Watson JC. The second ASRA practice advisory on neurologic complications associated with regional anesthesia and pain medicine: executive summary 2015. Regional Anesthesia & Pain Medicine. 2015 Sep 1;40(5):401-30.
24. Liu SS, YaDeau JT, Shaw PM, Wilfred S, Shetty T, Gordon M. Incidence of unintentional intraneural injection and postoperative neurological complications with ultrasound‐guided interscalene and supraclavicular nerve blocks. Anaesthesia. 2011 Mar;66(3):168-74.
25. Hara K, Sakura S, Yokokawa N, Tadenuma S. Incidence and effects of unintentional intraneural injection during ultrasound-guided subgluteal sciatic nerve block. Regional Anesthesia & Pain Medicine. 2012 May 1;37(3):289-93.
26. Hovgesen CH, Wilhjelm JE, Vilmann P, Kalaitzakis E. Echogenic surface enhancements for improving needle visualization in ultrasound: A PRISMA systematic review. Journal of Ultrasound in Medicine. 2022 Feb;41(2):311-25.
27. Hebard S, Hocking G. Echogenic technology can improve needle visibility during ultrasound-guided regional anesthesia. Regional Anesthesia & Pain Medicine. 2011 Feb 1;36(2):185-9.
28. Nakagawa K, Kamiya T, Arakawa K, Akiyama S, Sakai K. Objective and subjective comparison of the visibility of three echogenic needles and a nonechogenic needle on older ultrasound devices. Acta Anaesthesiologica Taiwanica. 2015 Mar 1;53(1):1-6.
29. Reina MA, Sala-Blanch X, Monzó E, Nin OC, Bigeleisen PE, Boezaart AP. Extrafasicular and Intraperineural, but No Endoneural, Spread after Deliberate Intraneural Injections in a Cadaveric Study. Anesthesiology. 2019 Jun 1;130(6):1007-16.
30. Gadsden JC, Choi JJ, Lin E, Robinson A. Opening injection pressure consistently detects needle–nerve contact during ultrasound-guided interscalene brachial plexus block. Anesthesiology. 2014 May 1;120(5):1246-53.
31. Vučković I, Dilberović F, Kulenović A, Divanović KA, Voljevica A, Kapur E. Injection pressure as a marker of intraneural injection in procedures of peripheral nerves blockade. Bosnian Journal of Basic Medical Sciences. 2006 Nov;6(4):5.
32. Vermeylen K, Hermans M, Soetens F, Vereecke E, Steinfeldt T, Groen G, Hadzic A, Van de Velde M. Opening injection pressure is higher in intraneural compared with perineural injections during simulated nerve blocks of the lower limb in fresh human cadavers. Regional Anesthesia & Pain Medicine. 2017 May 1;42(3):362-7.
33. O’Flaherty D, McCartney CJ, Ng SC. Nerve injury after peripheral nerve blockade—current understanding and guidelines. BJA education. 2018 Dec 1;18(12):384-90.
34. Paśnicki M, Król A, Kosson D, Kołacz M. The safety of peripheral nerve blocks: the role of triple monitoring in regional anaesthesia, a comprehensive review. InHealthcare 2024 Apr 1 (Vol. 12, No. 7, p. 769). MDPI.
35. Mika S, Gola W, Gil-Mika M, Wilk M, Misiołek H. Artificial intelligence-supported ultrasonography in anesthesiology: Evaluation of a patient in the operating theatre. Journal of Personalized Medicine. 2024 Mar 15;14(3):310.
36. Marino M, Hagh R, Hamrin Senorski E, Longo UG, Oeding JF, Nellgard B, Szell A, Samuelsson K. Artificial intelligence‐assisted ultrasound‐guided regional anaesthesia: An explorative scoping review. Journal of Experimental Orthopaedics. 2024 Jul;11(3):e12104.
37. Viderman D, Dossov M, Seitenov S, Lee MH. Artificial intelligence in ultrasound-guided regional anesthesia: A scoping review. Frontiers in medicine. 2022 Oct 25;9:994805.
38. Bowness JS, Metcalfe D, El-Boghdadly K, Thurley N, Morecroft M, Hartley T, Krawczyk J, Noble JA, Higham H. Artificial intelligence for ultrasound scanning in regional anaesthesia: a scoping review of the evidence from multiple disciplines. British Journal of Anaesthesia. 2024 May 1;132(5):1049-62.
39. Cascella M, Tracey MC, Petrucci E, Bignami EG. Exploring artificial intelligence in anesthesia: a primer on ethics, and clinical applications. Surgeries. 2023 May 29;4(2):264-74.
40. Bigeleisen PE. Nerve puncture and apparent intraneural injection during ultrasound-guided axillary block does not invariably result in neurologic injury. Anesthesiology. 2006 Oct;105(4):779-83.
| How to Cite this Article: Arora D. Intrafascicular Injection: Can AI, Ultrasound, Pressure Monitoring, and Echogenic Needles Prevent It? International Journal of Regional Anaesthesia. January-June 2025; 6(1): 08-14. DOI: https://doi.org/10.13107/ijra.2025.v06.i01.114 |
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