Articles: peripheral-nerve-injuries.
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Minerva anestesiologica · Jan 2011
ReviewIntraneural injections and regional anesthesia: the known and the unknown.
Peripheral nerve injury is a rare complication of regional anesthesia. Intraneural injections were once considered harbingers of neural injury with practitioners focusing on their avoidance. ⋯ We also now have a better understanding of the multifactorial nature of neurologic injury based on the nerve anatomy, site of needle insertion, bevel type, location of the needle tip, pressure achieved during injection, and underlying patient factors. Using ultrasound guidance during nerve blocks has revealed that not all intraneural injections result in injury, and its use will continue to provide insight into the mechanism of anesthetic-related nerve injury.
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Complications of peripheral nerve blocks are fortunately rare, but can be devastating for both the patient and the anaesthesiologist. This review will concentrate on current knowledge about peripheral nerve injury secondary to nerve blocks, complications from continuous peripheral nerve catheter techniques, and local anaesthetic systemic toxicity.
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To prevent peripheral nerve injury and neuropathic pain resulting from venipuncture, medical students and medical workers should be educated about the following points in clinical practice. First, the medial aspect of the antecubital fossa should not be punctured, to prevent injury to the median and medial anterobrachial cutaneous nerves. Second, the symptoms and signs of neuropathic pain resulting from venipuncture should be taught, to recognize the onset of neuropathic pain. Third, pharmacotherapy for the management of neuropathic pain should be taught to treat neuropathic pain resulting from venipuncture.
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Peripheral nerve injury activates spinal microglia. This leads to enduring changes in the properties of dorsal horn neurons that initiate central sensitization and the onset of neuropathic pain. Although a variety of neuropeptides, cytokines, chemokines and neurotransmitters have been implicated at various points in this process, it is possible that much of the information transfer between activated microglia and neurons, at least in this context, may be explicable in terms of the actions of brain derived neurotrophic factor (BDNF). ⋯ A very similar 'injury footprint' is seen following long-term exposure to BDNF. This review presents new information on the action of BDNF and CCI on lamina II neurons, including the similarity of their actions on the kinetics and distributions of subpopulations of miniature excitatory postsynaptic currents (mEPSC). These findings raise the possibility that BDNF functions as a final common path for a convergence of perturbations that culminate in the generation of neuropathic pain.
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Incidence of peripheral nerve injury in extremity trauma is low, with reported rates of 1.5 to 2.8%; however there is significant associated morbidity and outcomes of peripheral nerve repair are poor, especially when delayed. In this article, we provide a brief review of pathophysiology, classification, and surgery of peripheral nerve injuries, with special emphasis on wartime injuries.