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Optical detection of vascular penetration during nerve blocks: an in vivo human study.

Abstract：

BACKGROUND AND OBJECTIVES:Complications resulting from vascular penetration during nerve blocks are rare but potentially devastating events that can occur despite meticulous technique. In this in vivo human pilot study, we investigated the potential for detecting vascular penetration with optical reflectance spectroscopy during blocks of the sympathetic chain and the communicating ramus at lumbar levels. METHODS:A custom-designed needle stylet with integrated optical fibers was used in combination with a commercial needle shaft. The needle stylet was connected to a console that delivered broadband light to tissue and spectrally resolved light that was scattered near the stylet tip. A total of 18 insertions were performed on 10 patients; testing for vascular penetration at the nerve target region was performed with aspiration and with radio-opaque contrast injections, visualized fluoroscopically. Optical absorption by hemoglobin was quantified with a blood parameter that was calculated from each spectrum. The blood parameter provided a measure of the difference between spectra acquired from the nerve target region and reference spectra acquired from blood extracted from a volunteer. RESULTS:In 2 insertions, vascular penetration was detected. Pronounced optical absorption by hemoglobin was observed to be associated with both of these events and absent in all other cases. The difference between the blood parameters obtained when vascular penetration was detected, and all other blood parameters were statistically significant (P = 0.006), with a diagnostic odds ratio of 35.4 (confidence interval, 2.21 to ∞). CONCLUSIONS:The results from this study suggest that optical spectroscopy has the potential to detect intravascular needle placement, which may in turn increase the safety of nerve blocks.

journal_name

Reg Anesth Pain Med

journal_title

Regional anesthesia and pain medicine

authors

Balthasar A,Desjardins AE,van der Voort M,Lucassen GW,Roggeveen S,Wang K,Bierhoff W,Kessels AG,Sommer M,van Kleef M

doi

10.1097/AAP.0b013e3182377ff1

subject

Has Abstract

pub_date

2012-01-01 00:00:00

pages

3-7

issue

eissn

1098-7339

issn

1532-8651

journal_volume

pub_type

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Optical detection of vascular penetration during nerve blocks: an in vivo human study.