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Related Concept Videos

Local Anesthetics: Clinical Application as Intravenous Regional Anesthesia01:16

Local Anesthetics: Clinical Application as Intravenous Regional Anesthesia

Intravenous regional anesthesia or the Bier block technique is used to anesthetize a specific limb or extremity. It uses exsanguinated or blood-drained vessels to transport local anesthetics or LAs to the peripheral nerve trunks. Lidocaine without vasoconstrictors like epinephrine is most commonly used for this technique. Other drugs used are prilocaine, ropivacaine, and chloroprocaine. Bupivacaine is not recommended for this technique due to its high cardiac toxicity.
One of the advantages of...
Local Anesthetics: Clinical Application as Spinal Anesthesia01:11

Local Anesthetics: Clinical Application as Spinal Anesthesia

Spinal anesthetics are given during lower abdomen and limb surgeries to block sensory and motor neurons. They are administered in the mid to low lumbar regions, primarily acting on the cauda equina's nerve roots. The blockade level depends on the local anesthetic (LA) concentration. Usually, low LA concentrations are sufficient to block sensory fibers, while only high LA concentrations block motor fibers. Other factors like injection volume and speed, the patient's posture, and the drug...
Local Anesthetics: Clinical Application as Surface, Infiltration, and Conduction Block Anesthesia01:30

Local Anesthetics: Clinical Application as Surface, Infiltration, and Conduction Block Anesthesia

Depending on the target organ, local anesthetics (LAs) can be administered via various routes. In surface anesthesia, LAs are applied directly to the surface of the skin or mucous membranes. It is widely used for topical skin numbing before venipuncture or minor surgical procedures. Commonly used surface local anesthetics are lidocaine or benzocaine sprays or creams. Surface anesthesia occurs within 5 minutes and lasts for about 60 minutes. One of the main disadvantages of topical anesthesia is...
Local Anesthetics: Differential Sensitivity of Nerve Fibers01:24

Local Anesthetics: Differential Sensitivity of Nerve Fibers

Local anesthetics (LAs) block the sodium channels of nerve trunks, sensory nerve endings, and neuromuscular junctions. Although LAs can block all kinds of nerves, the sensitivity of nerve fibers differs according to nerve types and structures. LAs are known to block myelinated fibers faster than unmyelinated ones. Also, they block pain or sensory neurons at low concentrations without affecting the motor neurons involved in muscle contractions. This helps relieve labor pain without affecting the...

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Electrophysiological Methods to Assess Peripheral Pain Block in an Anesthetized Rat
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Published on: November 21, 2025

Intraneural injection with low-current stimulation during popliteal sciatic nerve block.

Christopher Robards1, Admir Hadzic, Lakshmanasamy Somasundaram

  • 1Departments of Anesthesia, University Hospital of Columbia University, College of Physicians and Surgeons, New York City, New York 10025, USA.

Anesthesia and Analgesia
|July 18, 2009
PubMed
Summary

Intraneural needle placement is common during low-current electrical nerve localization for popliteal sciatic nerve blocks. Absence of motor response does not rule out intraneural placement, potentially leading to more needle attempts.

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Area of Science:

  • Anesthesiology
  • Neurology
  • Medical Imaging

Background:

  • Preventing intraneural injection during peripheral nerve blockade is crucial for avoiding neurologic injury.
  • The precise needle-nerve relationship during low-current electrical nerve localization remains poorly understood.

Purpose of the Study:

  • To investigate the frequency of intraneural needle tip location during low-current stimulation for popliteal sciatic nerve blockade.
  • To assess the relationship between motor response thresholds and intraneural needle placement.

Main Methods:

  • Prospective study of 24 patients undergoing popliteal sciatic nerve block using ultrasound and nerve stimulator guidance.
  • Needle advancement endpoint: motor response (0.2-0.5 mA) or apparent intraneural tip on ultrasound.
  • Intraneural injection defined by injectate causing swelling and compartmentalization within the epineurium.

Main Results:

  • Intraneural needle placement occurred in 83.3% of patients before eliciting a motor response.
  • In 16.7% of patients, no motor response was obtained even after intraneural needle entry.
  • All blocks achieved adequate anesthesia, and no postoperative neurologic dysfunction was observed.

Conclusions:

  • Absence of motor response to low-current stimulation does not exclude intraneural needle placement.
  • Low-current stimulation is associated with a high incidence of intraneural needle placement during popliteal sciatic nerve blocks.
  • Relying solely on motor response may lead to unnecessary needle manipulation.