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Published on: September 26, 2018
Case report: Neurological deficit associated with intraneural needle placement without injection
1Department of Anaesthesiology, University of Auckland, Anaesthesia Institute, Newmarket, Auckland, New Zealand. fredrickson@actrix.co.nz
Canadian Journal of Anaesthesia = Journal Canadien D'Anesthesie
|September 26, 2009
Summary
Intraneural needle placement, even without injection, can cause severe nerve injury. This case report highlights the risks of inadvertent median nerve penetration, emphasizing the need for caution during procedures near nerves.
Area of Science:
- Neurology
- Ultrasound Imaging
- Anesthesiology
Background:
- Recent literature suggests subepineural injection of local anesthetics may be safe.
- This contrasts with established risks of intraneural needle placement.
Observation:
- A case of inadvertent median nerve penetration by a venous cannulation needle is described.
- The needle was positioned immediately posterior to the targeted median cubital vein.
- Penetration caused sudden, severe lancinating pain in the median nerve's sensory distribution.
Findings:
- Ultrasound confirmed the median nerve's proximity to the venipuncture site.
- Persistent sensory symptoms (numbness, tingling, pain, altered sensation) in the median nerve distribution lasted over six weeks.
- The injury occurred irrespective of any anesthetic injection.
Implications:
- This case underscores the significant risks associated with intraneural needle placement.
- It highlights the potential for nerve damage even when no injection is administered.
- Emphasizes the critical importance of precise needle guidance and anatomical awareness during procedures near nerves.