Electron microscopic examination of needles used in infraclavicular brachial plexus block



Infraclavicular block, Electron microscopy, Neuronal Damage


Aim: The application of peripheral block is frequently used in anesthesia practice. One of the most significant complications of this procedure is peripheral nerve damage that can develop due to the needles used. The aim of this study was to determine the presence of tissue residue on the needle and to obtain information about damage to surrounding tissues during this procedure by examining the needles used in brachial plexus block with electron microscopy. 

Methods: This prospective-cohort study included patients who were to undergo forearm or hand surgery in the Orthopedics Clinic under anesthesia with infraclavicular brachial plexus block performed with 2 different techniques: The local anesthetic agent was administered to the subclavian artery at 6 and 9 o’clock levels in Group 1 and 2, 6 and 9 o’clock levels in Group 2. The needles used during the block were preserved in glutaraldehyde solution then examined with electron microscopy. The presence of tissue on the needles was recorded and statistical evaluations were made. 

Results: The needles used in two different techniques of infraclavicular brachial plexus block were examined under scanning electron microscope. The amount of tissue residue remaining on the needle in Group 1 was significantly less than that in Group 2 (P<0.001). 

Conclusion: When it is considered that ultrasound provides a 2-dimensional image, the fewer the number of needle manipulations made during the procedure of brachial plexus block application, the less damage will be made to the surrounding tissues, thus reducing the possibility of mechanical nerve damage.


Download data is not yet available.


Casati A, Danelli G, Baciarello M, et al. A prospective, randomized comparison between ultrasound and nerve stimulation guidance for multiple injection axillary brachial plexus block. Anesthesiology. 2007;106:992–6.

Perlas A, Brull R, Chan VW, McCartney CJ, Nuica A, Abbas S. Ultrasound guidance improves the success of sciatic nerve block at the popliteal fossa. Regional Anesthesia and Pain Medicine. 2008;33:259–65.

Oberndorfer U, Marhofer P, Bosenberg A, et al. Ultrasonographic guidance for sciatic and femoral nerve blocks in children. British Journal of Anaesthesia. 2007;98:797–801.

Marhofer P, Sitzwohl C, Greher M, Kapral S. Ultrasound guidance for infraclavicular brachial plexus anaesthesia in children. Anaesthesia. 2004;59:642–6.

Hadzic A, Sala-Blanch X, Xu D. Ultrasound guidance may reduce but not eliminate complications of peripheral nevre blocks. Anesthesiology. 2008;108:557–8.

Neal JM, Bernards CM, Hadzic A, et al. Asra practice advisory on neurologic complications in regional anesthesia and pain medicine. Regional Anesthesia and Pain Medicine. 2008;33:404–15.

Bernards CM, Hadzic A, Suresh S, Neal JM. Regional anesthesia in anesthetized or heavily sedated patients. Regional Anesthesia and Pain Medicine. 2008;33:449–60.

Reina, Miguel Angel, et al. Electron microscopy and the expansion of regional anesthesia knowledge. Techniques in Regional Anesthesia and Pain Management. 2002;6(4):165-71.

Taboada M, Rodriquez J, Amor M. Is ultrasound guidance superior to conventional nerve stimulation for coracoid infraclavicular brachial plexus block? Reg Anesth Pain Med. 2009;34:357–60.

Liu SS, YaDeau JT, Shaw PM, Wilfred S, Shetty T, Gordon M. Incidence of unintentional intraneural injection and postoperative neurological complications with ultrasound-guided interscalene and supraclavicular nerve blocks. Anaesthesia. 2011;66:168–74.

Robards C, Hadzic A, Somasundaram L, et al. Intraneural injection with low-current stimulation during popliteal sciatic nerve block. Anesthesia and Analgesia. 2009;109: 673-7.

Hara K, Sakura S, Yokokawa N, Tadenuma S. Incidence and effects of unintentional intraneural injection during ultrasound – guided subgluteal sciatic nerve block. Reg Anesth Pain Med. 2012;37:289-93.

Desgagnes MC, Levesque S, Dion N, et al. A comparison of a single or triple injection technique for ultrasound-guided infraclavicular block: a prospective randomized controlled study. Anesth Analg. 2009;109:668-72.

Tran de QH, Bertini P, Zaouter C, Munoz L, Finlayson RJ. A prospective, randomized comparison between single and double injection ultrasound-guided infraclavicular brachial plexus block. Reg Anesth Pain Med. 2010;35:16-21.

Fredrickson MJ, Wolstencroft P, Kejriwal R, Yoon A, Boland MR, Chinchanwala S. Single versus triple injection ultrasound-guided infraclavicular block: confirmation of the effectiveness of the single injection technique. Anesth Analg. 2010 Nov;111(5):1325-7.

Bowens C Jr, Gupta RK. et al. Selective local anesthetic placement using ultrasound guidance and neurostimulation for infraclavicular brachial plexus block. Anesth Analg 2010;110:1480–5

Sermeus LA, Sala-Blanch X, McDonnell JG, Lobo CA, Nicholls BJ, van Geffen GJ, et al. Ultrasound-guided approach to nerves (direct vs. tangential) and the incidence of intraneural injection: a cadaveric study. Anaesthesia. 2017 Apr;72(4):461-9.






Research Article

How to Cite

Bilal B, Boran Ömer F, Sargon M, Başaran KE, Doğaner A. Electron microscopic examination of needles used in infraclavicular brachial plexus block. J Surg Med [Internet]. 2020 Jan. 2 [cited 2022 Aug. 10];4(1):5-8. Available from: https://jsurgmed.com/article/view/661093