title: Incidence of unintentional intraneural injection and postoperative neurological complications with ultrasound-guided interscalene and supraclavicular nerve blocks.
abstract: It is proposed that ultrasound guidance decreases the risk of intraneural injection and associated postoperative neurological complications. However, the incidence of unintentional intraneural injection with ultrasound is unknown. Two hundred and fifty-seven patients were enrolled in a prospective, single-blind observational study. All patients underwent a pre-operative neurological examination before ambulatory shoulder arthroscopy with sedation and ultrasound-guided interscalene or supraclavicular block. Patients were followed up at 1 week and at 4-6 weeks postoperatively. Two blinded anaesthesiologists viewed the same video of the ultrasound image during the block offline to determine intraneural trespass. Intraneural injection occurred in 42 patients (17%; 95% CI 12-22%). No patient suffered from postoperative neurological complications (0%; 95% CI 0-1.6%) at follow-up.
authors.affiliation: Hospital for Special Surgery, Weill Cornell Medical College, New York, USA. liusp@hss.edu
authors.forename: S S
authors.initials: SS
authors.lastname: Liu
authors.forename: J T
authors.initials: JT
authors.lastname: YaDeau
authors.forename: P M
authors.initials: PM
authors.lastname: Shaw
authors.forename: S
authors.initials: S
authors.lastname: Wilfred
authors.forename: T
authors.initials: T
authors.lastname: Shetty
authors.forename: M
authors.initials: M
authors.lastname: Gordon
mesh_terms: D000328:Adult; D000556:Ambulatory Surgical Procedures / Q000379:methods; D001182:Arthroscopy / Q000379:methods; D001917:Brachial Plexus / Q000000981:diagnostic imaging / Q000293:injuries*; D020516:Brachial Plexus Neuropathies / Q000209:etiology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009407:Nerve Block / Q000009:adverse effects* / Q000295:instrumentation / Q000379:methods; D011446:Prospective Studies; D012785:Shoulder Joint / Q000601:surgery; D016037:Single-Blind Method; D018084:Ultrasonography, Interventional / Q000379:methods