{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,15]],"date-time":"2026-01-15T05:13:43Z","timestamp":1768454023520,"version":"3.49.0"},"reference-count":30,"publisher":"BMJ","issue":"11","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Reg Anesth Pain Med"],"accepted":{"date-parts":[[2022,7,16]]},"published-print":{"date-parts":[[2022,11]]},"abstract":"<jats:p>Despite advances in needle positioning techniques, nerve damage still occurs after regional anesthesia. Recognized causes include local anesthetic toxicity, subperineural injection, high subepineural fluid injection pressures and subepineural hematoma after forceful needle-\u2013nerve contact.<\/jats:p>\n               <jats:p>We hypothesize that subperineural injection is still possible, but less likely to be the cause of nerve damage because needle penetration of fascicles and mechanical damage is difficult to achieve. High-resolution (75\u2009\u00b5m) 40 MHz micro-ultrasound images of pig axillae show short-bevelled 22\u2009g, 0.7\u2009mm wide block needles that are three times larger than the average fascicle. Fascicular bundles are extremely difficult to puncture because they spin away on needle contact. Histology from fresh cadavers after supposed intrafascicular injection shows fluid spread within perineurium and intrafascicular perineural septae, but no breach of endoneurium or axons.<\/jats:p>\n               <jats:p>We propose that mechanotransduction, the cellular changes that occur in response to force, contributes to nerve damage. Piezo ion channel proteins transduce force into electrical activity by rapid entry of cations into cells. Excessive Ca<jats:sup>2+<\/jats:sup> influx into cells has the potential to inhibit nerve regeneration. Cellular changes include regulation of gene expression. The forces associated with purposeful needle insertion are generally unknown. Our experiments in the soft embalmed Thiel cadaver showed a lognormal range of forces between 0.6 N and 16.8 N on epineural penetration.<\/jats:p>\n               <jats:p>We hypothesize that forceful needle injury may cause nerve damage by activation of Piezo receptors and release of intracellular Ca<jats:sup>2+<\/jats:sup>.<\/jats:p>","DOI":"10.1136\/rapm-2022-103583","type":"journal-article","created":{"date-parts":[[2022,7,25]],"date-time":"2022-07-25T11:50:14Z","timestamp":1658749814000},"page":"703-706","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":3,"title":["Traumatic needle damage to nerves during regional anesthesia: presentation of a novel mechanotransduction hypothesis"],"prefix":"10.1136","volume":"47","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5931-1362","authenticated-orcid":false,"given":"Graeme A","family":"McLeod","sequence":"first","affiliation":[{"name":"Department of Anaesthesia, NHS Tayside, Dundee, UK"},{"name":"Division of Imaging and Technology, University of Dundee, Dundee, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Amy","family":"Sadler","sequence":"additional","affiliation":[{"name":"Department of Anaesthesia, NHS Tayside, Dundee, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2040-9714","authenticated-orcid":false,"given":"Tim G","family":"Hales","sequence":"additional","affiliation":[{"name":"Division of Systems Medicine, University of Dundee, Dundee, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2022,7,25]]},"reference":[{"key":"2025101113071384000_47.11.703.1","doi-asserted-by":"crossref","first-page":"1050","DOI":"10.1002\/ca.23253","article-title":"A novel marker for identifying and studying the membranes, barriers, and compartments surrounding peripheral nerves microscopically","volume":"31","author":"Reina","year":"2018","journal-title":"Clin Anat"},{"key":"2025101113071384000_47.11.703.2","doi-asserted-by":"crossref","first-page":"1007","DOI":"10.1097\/ALN.0000000000002647","article-title":"Extrafasicular and Intraperineural, but no Endoneural, spread after deliberate intraneural injections in a cadaveric study","volume":"130","author":"Reina","year":"2019","journal-title":"Anesthesiology"},{"key":"2025101113071384000_47.11.703.3","doi-asserted-by":"publisher","DOI":"10.1097\/00000542-200110000-00015"},{"key":"2025101113071384000_47.11.703.4","doi-asserted-by":"publisher","DOI":"10.1097\/AAP.0000000000000286"},{"key":"2025101113071384000_47.11.703.5","doi-asserted-by":"publisher","DOI":"10.1097\/AAP.0000000000000125"},{"key":"2025101113071384000_47.11.703.6","doi-asserted-by":"crossref","first-page":"645","DOI":"10.1213\/ANE.0000000000001804","article-title":"Factors associated with risk of neurologic complications after peripheral nerve 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electrophysiologic effects","volume":"129","author":"Cappelleri","year":"2018","journal-title":"Anesthesiology"},{"key":"2025101113071384000_47.11.703.19","doi-asserted-by":"publisher","DOI":"10.1136\/rapm-2018-100087"},{"key":"2025101113071384000_47.11.703.20","doi-asserted-by":"crossref","first-page":"209","DOI":"10.1111\/anae.15211","article-title":"The effect of an ultrasound-activated needle tip tracker needle on the performance of sciatic nerve block on a soft embalmed Thiel cadaver","volume":"76","author":"McKendrick","year":"2021","journal-title":"Anaesthesia"},{"key":"2025101113071384000_47.11.703.21","doi-asserted-by":"crossref","first-page":"153","DOI":"10.1016\/j.bja.2021.03.036","article-title":"Real-Time visualisation of peripheral nerve trauma during subepineural injection in pig brachial plexus using micro-ultrasound","volume":"127","author":"Chandra","year":"2021","journal-title":"Br J 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Needle insertion forces and fluid injection pressures during targeting of nerves in a soft embalmed cadaver model. 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