Long-Tapered Double Needle Used to Reduce Needle Stick Nerve Injury

1997 ◽  
Vol 22 (2) ◽  
pp. 157-160 ◽  
Author(s):  
Masaaki Maruyama
Keyword(s):  
Peripheral Nerve ◽  
Nerve Injury ◽  
Nerve Block ◽  
Type A ◽  
Nerve Fibers ◽  
Nerve Injuries ◽  
Anesthetic Solution ◽  
New Type ◽  
Histologic Specimen ◽  
Hematoxylin Eosin

Background and ObjectivesNeedle trauma may cause peripheral nerve injuries during performance of peripheral nerve block.MethodsFour types of 21-gauge needles for regional anesthesia were compared: a beveled nerve block needle (Quincke type); a short-tapered needle with a side orifice (Whitacre type); a long-tapered needle with a side orifice (Sprotte type); and a long-tapered double needle combining an inner pencil-point fine needle with an outer truncated conical needle (a new type). This new needle was developed to reduce the potential for nerve injury while retaining a suitable flow rate of anesthetic solution and the ability to inject the solution precisely at the point of paresthesia elicited by the tip. Each type of needle was used to produce puncture injuries to rabbit sciatic nerves. Eighteen specimens were studied within each needle group. The beveled needle was used to produce two different types of nerve injuries by inserting it either transverse or longitudinal to the nerve fibers. Each histologic specimen of the nerve with the needle puncture was surfacestained with hematoxylin-eosin and Bodian's method. Subsequently, the number of damaged axons was histomorphologically counted and statistically evaluated.ResultsBoth long-tapered needles produced significantly fewer transected axons than the beveled needle inserted with the bevel longitudinal to the nerve fibers.ConclusionThe long-tapered needles produced the least number of transected nerve fibers after sciatic nerve puncture.

scholarly journals 4.7-T diffusion tensor imaging of acute traumatic peripheral nerve injury

2015 ◽  
Vol 39 (3) ◽  
pp. E9 ◽  
Author(s):  
Richard B. Boyer ◽  
Nathaniel D. Kelm ◽  
D. Colton Riley ◽  
Kevin W. Sexton ◽  
Alonda C. Pollins ◽  
...  
Keyword(s):  
Diffusion Tensor Imaging ◽  
High Resolution ◽  
Peripheral Nerve ◽  
Nerve Injury ◽  
Peripheral Nerve Injury ◽  
Diffusion Tensor ◽  
Ex Vivo ◽  
Nerve Fibers ◽  
Nerve Transection ◽  
Nerve Injuries

Diagnosis and management of peripheral nerve injury is complicated by the inability to assess microstructural features of injured nerve fibers via clinical examination and electrophysiology. Diffusion tensor imaging (DTI) has been shown to accurately detect nerve injury and regeneration in crush models of peripheral nerve injury, but no prior studies have been conducted on nerve transection, a surgical emergency that can lead to permanent weakness or paralysis. Acute sciatic nerve injuries were performed microsurgically to produce multiple grades of nerve transection in rats that were harvested 1 hour after surgery. High-resolution diffusion tensor images from ex vivo sciatic nerves were obtained using diffusion-weighted spin-echo acquisitions at 4.7 T. Fractional anisotropy was significantly reduced at the injury sites of transected rats compared with sham rats. Additionally, minor eigenvalues and radial diffusivity were profoundly elevated at all injury sites and were negatively correlated to the degree of injury. Diffusion tensor tractography showed discontinuities at all injury sites and significantly reduced continuous tract counts. These findings demonstrate that high-resolution DTI is a promising tool for acute diagnosis and grading of traumatic peripheral nerve injuries.

Human motor endplate remodeling after traumatic nerve injury

2020 ◽  
pp. 1-8
Author(s):  
Ranjan Gupta ◽  
Justin P. Chan ◽  
Jennifer Uong ◽  
Winnie A. Palispis ◽  
David J. Wright ◽  
...  
Keyword(s):  
Peripheral Nerve ◽  
Nerve Injury ◽  
Surgical Intervention ◽  
Linear Regression Analysis ◽  
Motor Endplate ◽  
Nerve Injuries ◽  
Denervated Muscle ◽  
Sequence Of Events ◽  
Human Motor ◽  
Denervated Muscles

OBJECTIVECurrent management of traumatic peripheral nerve injuries is variable with operative decisions based on assumptions that irreversible degeneration of the human motor endplate (MEP) follows prolonged denervation and precludes reinnervation. However, the mechanism and time course of MEP changes after human peripheral nerve injury have not been investigated. Consequently, there are no objective measures by which to determine the probability of spontaneous recovery and the optimal timing of surgical intervention. To improve guidance for such decisions, the aim of this study was to characterize morphological changes at the human MEP following traumatic nerve injury.METHODSA prospective cohort (here analyzed retrospectively) of 18 patients with traumatic brachial plexus and axillary nerve injuries underwent biopsy of denervated muscles from the upper extremity from 3 days to 6 years after injury. Muscle specimens were processed for H & E staining and immunohistochemistry, with visualization via confocal and two-photon excitation microscopy.RESULTSImmunohistochemical analysis demonstrated varying degrees of fragmentation and acetylcholine receptor dispersion in denervated muscles. Comparison of denervated muscles at different times postinjury revealed progressively increasing degeneration. Linear regression analysis of 3D reconstructions revealed significant linear decreases in MEP volume (R = −0.92, R2 = 0.85, p = 0.001) and surface area (R = −0.75, R2 = 0.56, p = 0.032) as deltoid muscle denervation time increased. Surprisingly, innervated and structurally intact MEPs persisted in denervated muscle specimens from multiple patients 6 or more months after nerve injury, including 2 patients who had presented > 3 years after nerve injury.CONCLUSIONSThis study details novel and critically important data about the morphology and temporal sequence of events involved in human MEP degradation after traumatic nerve injuries. Surprisingly, human MEPs not only persisted, but also retained their structures beyond the assumed 6-month window for therapeutic surgical intervention based on previous clinical studies. Preoperative muscle biopsy in patients being considered for nerve transfer may be a useful prognostic tool to determine MEP viability in denervated muscle, with surviving MEPs also being targets for adjuvant therapy.

scholarly journals Establishment of a Sheep Model for Hind Limb Peripheral Nerve Injury: Common Peroneal Nerve

2021 ◽  
Vol 22 (3) ◽  
pp. 1401
Author(s):  
Rui D. Alvites ◽  
Mariana V. Branquinho ◽  
Ana C. Sousa ◽  
Federica Zen ◽  
Monica Maurina ◽  
...  
Keyword(s):  
Peripheral Nerve ◽  
Nerve Injury ◽  
Peripheral Nerve Injury ◽  
Peroneal Nerve ◽  
Common Peroneal Nerve ◽  
Small Sample ◽  
Therapeutic Options ◽  
Nerve Injuries ◽  
Sheep Model ◽  
The Common

Thousands of people worldwide suffer from peripheral nerve injuries and must deal daily with the resulting physiological and functional deficits. Recent advances in this field are still insufficient to guarantee adequate outcomes, and the development of new and compelling therapeutic options require the use of valid preclinical models that effectively replicate the characteristics and challenges associated with these injuries in humans. In this study, we established a sheep model for common peroneal nerve injuries that can be applied in preclinical research with the advantages associated with the use of large animal models. The anatomy of the common peroneal nerve and topographically related nerves, the functional consequences of its injury and a neurological examination directed at this nerve have been described. Furthermore, the surgical protocol for accessing the common peroneal nerve, the induction of different types of nerve damage and the application of possible therapeutic options were described. Finally, a preliminary morphological and stereological study was carried out to establish control values for the healthy common peroneal nerves regarding this animal model and to identify preliminary differences between therapeutic methods. This study allowed to define the described lateral incision as the best to access the common peroneal nerve, besides establishing 12 and 24 weeks as the minimum periods to study lesions of axonotmesis and neurotmesis, respectively, in this specie. The post-mortem evaluation of the harvested nerves allowed to register stereological values for healthy common peroneal nerves to be used as controls in future studies, and to establish preliminary values associated with the therapeutic performance of the different applied options, although limited by a small sample size, thus requiring further validation studies. Finally, this study demonstrated that the sheep is a valid model of peripheral nerve injury to be used in pre-clinical and translational works and to evaluate the efficacy and safety of nerve injury therapeutic options before its clinical application in humans and veterinary patients.

scholarly journals Permanent central synaptic disconnection of proprioceptors after nerve injury and regeneration. I. Loss of VGLUT1/IA synapses on motoneurons

2011 ◽  
Vol 106 (5) ◽  
pp. 2450-2470 ◽  
Author(s):  
Francisco J. Alvarez ◽  
Haley E. Titus-Mitchell ◽  
Katie L. Bullinger ◽  
Michal Kraszpulski ◽  
Paul Nardelli ◽  
...  
Keyword(s):  
Peripheral Nerve ◽  
Nerve Injury ◽  
Cell Body ◽  
Peripheral Nerve Injury ◽  
Motor Coordination ◽  
Electrophysiological Study ◽  
Peripheral Nerve Injuries ◽  
Nerve Injuries ◽  
Ia Afferent ◽  
Axon Collaterals

Motor and sensory proprioceptive axons reinnervate muscles after peripheral nerve transections followed by microsurgical reattachment; nevertheless, motor coordination remains abnormal and stretch reflexes absent. We analyzed the possibility that permanent losses of central IA afferent synapses, as a consequence of peripheral nerve injury, are responsible for this deficit. VGLUT1 was used as a marker of proprioceptive synapses on rat motoneurons. After nerve injuries synapses are stripped from motoneurons, but while other excitatory and inhibitory inputs eventually recover, VGLUT1 synapses are permanently lost on the cell body (75–95% synaptic losses) and on the proximal 100 μm of dendrite (50% loss). Lost VGLUT1 synapses did not recover, even many months after muscle reinnervation. Interestingly, VGLUT1 density in more distal dendrites did not change. To investigate whether losses are due to VGLUT1 downregulation in injured IA afferents or to complete synaptic disassembly and regression of IA ventral projections, we studied the central trajectories and synaptic varicosities of axon collaterals from control and regenerated afferents with IA-like responses to stretch that were intracellularly filled with neurobiotin. VGLUT1 was present in all synaptic varicosities, identified with the synaptic marker SV2, of control and regenerated afferents. However, regenerated afferents lacked axon collaterals and synapses in lamina IX. In conjunction with the companion electrophysiological study [Bullinger KL, Nardelli P, Pinter MJ, Alvarez FJ, Cope TC. J Neurophysiol (August 10, 2011). doi:10.1152/jn.01097.2010], we conclude that peripheral nerve injuries cause a permanent retraction of IA afferent synaptic varicosities from lamina IX and disconnection with motoneurons that is not recovered after peripheral regeneration and reinnervation of muscle by sensory and motor axons.

scholarly journals Perioperative Automated Noninvasive Blood Pressure- (NIBP-) Related Peripheral Nerve Injuries: An Anesthetist’s Dilemma—A Case Report and Review of the Literature

2020 ◽  
Vol 2020 ◽  
pp. 1-6
Author(s):  
Waleed Elmatite ◽  
Chanchal Mangla ◽  
Surjya Upadhyay ◽  
Joel Yarmush
Keyword(s):  
Blood Pressure ◽  
Peripheral Nerve ◽  
General Anesthesia ◽  
Nerve Injury ◽  
Blood Pressure Monitoring ◽  
Neurological Dysfunction ◽  
Motor Deficit ◽  
Nerve Injuries ◽  
Noninvasive Blood Pressure ◽  
Possible Cause

Peripheral nerve injury following regional or general anesthesia is a relatively uncommon entity but, potentially, a serious complication of anesthesia. Most nerve injuries are related to either regional anesthesia or position-related complications, and they are rarely seen in association with the use of automated blood pressure monitoring. We describe a patient who developed neurological dysfunction of all the three major nerves, median, ulnar, and radial, after general anesthesia. The distribution of sensory motor deficit along with the nerve conduction study demonstrated the location of the anatomical nerve lesions coinciding with the automatic noninvasive blood pressure (NIBP) cuff. No other cause of nerve injury was identified except for the use of the NIBP cuff. In the absence of another identifiable cause, we strongly suspected the NIBP cuff compression as a possible cause for the nerve injuries. In this article, we will discuss the possible risk factors, mechanisms, diagnosis, and prevention of perioperative nerve injury.

scholarly journals Series of Cases with Iatrogenic Nerve Injury

1970 ◽  
Vol 28 (2) ◽  
pp. 121-124
Author(s):  
Selina Daisy ◽  
Quazi Deen Mohammad ◽  
Azharul Hoque ◽  
Badrul Alam ◽  
Badrul Haque ◽  
...  
Keyword(s):  
Sciatic Nerve ◽  
Peripheral Nerve ◽  
Nerve Injury ◽  
Femoral Nerve ◽  
Accessory Nerve ◽  
Nerve Injuries ◽  
Sacral Plexus ◽  
Iatrogenic Injuries ◽  
Iatrogenic Nerve Injury ◽  
Femoral Nerve Injury

After introduction of EMG at Dhaka Medical Collage onJanuary 01, 2006, a total of 415 cases referred to EMGlaboratory for electrophysiological evaluation over a periodof two years(January 01, 2006 to December 31, 2007). Among these, 7cases diagnosed as iatrogenic nerve injuries. The subtypesof iatrogenic nerve injuries were:1. Accessory nerve injury: three, 2. Femoral nerve injury:one, 3. Sciatic nerve injury: one,4. Lumbar sacral plexus injury: one, 5. Combined sciaticand femoral nerve injury: oneIn order to investigate the causes, diagnosis & preventionof iatrogenic nerve injuries; we have reviewed 7 cases ofiatrogenic nerve injuries. The peripheral nerve injuriesoccurred due to lack of proper awareness of medicalpersonals. These injuries are iatrogenic injuries so it isuseful to review the mode of injuries and means ofprevention.DOI: 10.3329/jbcps.v28i2.5373J Bangladesh Coll Phys Surg 2010; 28: 121-124

scholarly journals Muscle graft as a substitute for peripheral nerve graft in rats

2009 ◽  
Vol 24 (3) ◽  
pp. 221-225 ◽  
Author(s):  
Aristides Palhares ◽  
Fausto Viterbo ◽  
Ricardo Galesso Cardoso
Keyword(s):  
Peripheral Nerve ◽  
Nerve Injury ◽  
Nerve Fibers ◽  
Nerve Graft ◽  
Muscle Graft ◽  
Nerve Grafts ◽  
Peripheral Nerve Graft ◽  
Histological Appearance ◽  
Almost All

PURPOSE: To evaluate the applicability of the use of autogenous muscle treated in various ways, as a substitute of the nerve grafts. METHODS: Rats were divided into seven groups that received, as a treatment for a standard nerve injury, the following types of grafts: fresh muscle, muscle fixed with 10% formaldehyde, muscle frozen in a freezer, muscle frozen in refrigerator, nerveless muscle, peripheral nerve and a group was without any treatment. It assessed the histological appearance of the nerve fibers in the segment repaired. RESULTS: The evaluation of the segment nervous repaired showed nerve fibers through the graft in almost all groups, but the methodology employed has not adequately characterized the differences between the groups. CONCLUSION: This study showed the migration of nerves fibers through all grafts used.

Nerve Injuries from Positioning and Regional Blocks

2017 ◽  
Author(s):  
Rajnish K. Gupta ◽  
Alexandria N. Nickless
Keyword(s):  
Peripheral Nerve ◽  
Nerve Injury ◽  
Perioperative Period ◽  
Peripheral Nerve Injuries ◽  
Nerve Injuries ◽  
Close Attention ◽  
Anesthetic Complications ◽  
Actual Incidence ◽  
Attention To Detail

Peripheral nerve injury in the perioperative period can have a variety of etiologies, including preexisting patient factors and by surgical and anesthetic complications such as intraoperative positioning and nerve blockade. The actual incidence may be difficult to assess, because most nerve injuries resolve with time and frequently require minimal to no intervention. Injuries often manifest more than 48 hours after surgery and have even been noted in patients who undergo awake procedures and in hospitalized patients who never undergo surgery. This should not negate the fact that close attention to detail when positioning patients and performing regional anesthesia may help decrease the overall incidence of nerve injury and should be considered in every anesthesiologist’s perioperative plan. This chapter reviews proper assessment, treatment, and follow-up for peripheral nerve injuries.

Chronic neuropathic pain after traumatic peripheral nerve injuries in the upper extremity: prevalence, demographic and surgical determinants, impact on health and on pain medication

2019 ◽  
Vol 20 (1) ◽  
pp. 95-108
Author(s):  
Adriana Miclescu ◽  
Antje Straatmann ◽  
Panagiota Gkatziani ◽  
Stephen Butler ◽  
Rolf Karlsten ◽  
...  
Keyword(s):  
Chronic Pain ◽  
Neuropathic Pain ◽  
Peripheral Nerve ◽  
Upper Extremity ◽  
Nerve Injury ◽  
Persistent Pain ◽  
Peripheral Nerve Injuries ◽  
Nerve Injuries ◽  
Chronic Neuropathic Pain ◽  
Younger Age

AbstractBackground and aimsAside from the long term side effects of a nerve injury in the upper extremity with devastating consequences there is often the problem of chronic neuropathic pain. The studies concerning the prevalence of persistent pain of neuropathic origin after peripheral nerve injuries are sparse. The prevalence and risk factors associated with chronic neuropathic pain after nerve injuries in the upper extremity were assessed.MethodsA standardized data collection template was employed prospectively and retrospectively for all patients with traumatic nerve injuries accepted at the Hand Surgery Department, Uppsala, Sweden between 2010 and 2018. The template included demographic data, pain diagnosis, type of injured nerve, level of injury, date of the lesion and repair, type of procedure, reoperation, time since the procedure, S-LANSS questionnaire (Self report-Leeds Assessment of Neuropathic Symptoms and Signs), RAND-36 (Item short form health survey), QuickDASH (Disability of Shoulder, Arm and Hand) and additional questionnaires concerned medication, pain intensity were sent to 1,051 patients with nerve injuries. Partial proportional odds models were used to investigate the association between persistent pain and potential predictors.ResultsMore than half of the patients undergoing a surgical procedure developed persistent pain. Prevalence of neuropathic pain was 73% of the patients with pain (S-LANSS ≥ 12 or more). Multivariate analysis indicated that injury of a major nerve OR 1.6 (p = 0.013), years from surgery OR 0.91 (p = 0.01), younger age OR 0.7 (p < 0.001), were the main factors for predicting pain after surgery. The type of the nerve injured was the strongest predictor for chronic pain with major nerves associated with more pain (p = 0.019).ConclusionsA high prevalence of chronic pain and neuropathic pain with a negative impact on quality of life and disability were found in patients after traumatic nerve injury. Major nerve injury, younger age and less time from surgery were predictors for chronic pain.

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