ESRA Academy. Pascarella G. Sep 8, 2016; 138404; 0247 Topic: Safety of Regional Anaesthesia - Complications - General Aspects
Dr. Giuseppe Pascarella
Dr. Giuseppe Pascarella

Access to Premium content is currently a membership benefit.

Click here to join ESRA or renew your membership.

Discussion Forum (0)
Rate & Comment (0)
Background and Aims:

Nerve injury with neurologic dysfunction is a feared, although uncommon, complication of peripheral nerve blockade as it may result in permanent disability.
The aim of this study was to test the effectiveness and safety of a triple monitoring (TM), i.e. a combination of ultrasounds (US), nerve stimulation (NS) and opening injection pressure (OIP), during interscalene brachial plexus block (BPB). Fig.1

The triple monitoring

Twenty patients undergoing interscalene BPB for shoulder arthroscopy received TM.
BSmart®, a single-use inline injection device connected to a 10 mL syringe, was used to detect OIP during interscalene BPB. The injection pressure was shown in colour-coded ranges provided by the piston.
Local anaesthetic was injected under US guidance between C5 and C6 roots. TM was performed according to the flowchart showed in Fig. 2.

Flowchart for triple monitoring

Data collection included the duration of block, the ability of US, NS and OIP to detect the needle-nerve contact, the presence of any pain during injection and the persistence of neurologic dysfunction at 24 h and at 1 month postoperatively.

Ethics Commette Approval

The mean duration of interscalene BPB was 68 seconds.
Needle-nerve contact was detected with NS in 6/20 patients despite the first control with US, whereas BSmart® detected more than 15 PSI (positive for needle-nerve contact) in 5/20 patients, despite a negative response of NS. Neither pain during injection nor postoperative neurologic dysfunctions were detected.


Ultrasounds, opening injection pressure and nerve stimulation are synergistic and additive, allowing the optimal placement of needle tip during injection.
Triple monitoring is fast to perform and improves interscalene brachial plexus block safety and patient comfort.

Code of conduct/disclaimer available in General Terms & Conditions
Anonymous User Privacy Preferences

Strictly Necessary Cookies (Always Active)

MULTILEARNING platforms and tools hereinafter referred as “MLG SOFTWARE” are provided to you as pure educational platforms/services requiring cookies to operate. In the case of the MLG SOFTWARE, cookies are essential for the Platform to function properly for the provision of education. If these cookies are disabled, a large subset of the functionality provided by the Platform will either be unavailable or cease to work as expected. The MLG SOFTWARE do not capture non-essential activities such as menu items and listings you click on or pages viewed.

Performance Cookies

Performance cookies are used to analyse how visitors use a website in order to provide a better user experience.

Google Analytics is used for user behavior tracking/reporting. Google Analytics works in parallel and independently from MLG’s features. Google Analytics relies on cookies and these cookies can be used by Google to track users across different platforms/services.

Save Settings