An improvised pressure gauge for regional nerve blockade/anesthesia injections: an initial study

High injection pressure is one of the warning signs of intraneural injection, with animal models suggesting pressures higher than 69 or 176 kPa as high risk, and is normally detected subjectively and inaccurately. We describe a system improvised from common clinical components that uses Boyle's law to objectively measure injection pressure. The objectives of the study were to (1) Validate our improvised pressure gauge (IPG) by comparing the injection pressure as calculated by Boyle's law against the measured pressure and (2) Use the IPG to measure the range of injection pressures by two groups of anesthetic professionals using the "syringe feel" technique. Our IPG system consists of an extended 1 ml syringe attached to a 3-way stopcock, inserted between the syringe containing the local anesthetic injectate and the needle. The IPG was validated against a pressure calibration reference. 20 anesthesiologists and 20 anesthetic assistants were recruited to apply pressure to the 20 ml syringe in vitro while blinded to the attached IPG. The pressures were measured on three separate occasions for each participant. There was good agreement (<8 percent difference) between the measured and theoretical pressure values. Anesthesiologists exceeded the threshold of 69 kPa in 18 of a total of 60 attempts whereas anesthetic assistants exceeded the threshold in 30 attempts out of 60 attempts. Anesthetic assistants exerted a higher overall pressure of 80 kPa compared to 51 kPa for anesthesiologists-this was statistically significant (p = 0.027). Our improvised system is easily and rapidly assembled from common clinical equipment and shows promise as a monitor for inadvertent intraneural injection.