{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T21:05:08Z","timestamp":1790715908155,"version":"4.1.0"},"reference-count":22,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2021,2,16]],"date-time":"2021-02-16T00:00:00Z","timestamp":1613433600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Nerve injury is a feared complication of peripheral nerve blockade. The aim of this study was to test the effectiveness of a triple monitoring (TM), i.e., a combination of ultrasound (US), nerve stimulation (NS) and opening injection pressure (OIP) during interscalene brachial plexus block (IBPB) for surgery of the shoulder. Sixty patients undergoing IBPB for shoulder arthroscopy received TM. BSmart\u00ae, an inline injection device connected to a 10 mL syringe, was used to detect OIP during IBPB. Nerve stimulation was set to 0.5 mA to rule out any motor response, and if OIP was below 15 PSI, 10 mL of local anaesthetic was injected under US guidance between the C5 and C6 roots. The main outcome was the ability of TM to detect a needle\u2013nerve contact. Other outcomes including the duration of IBPB; pain during injection; postoperative neurologic dysfunction. Triple monitoring revealed needle\u2013nerve contact in 33 patients (55%). In 18 patients, NS evoked motor responses despite first control with US; in a further 15 patients, BSmart\u00ae detected an OIP higher than 15 PSI, despite the absence of motor response to NS. Mean duration of IBPB was 67.2 \u00b1 5.3 seconds; neither pain during injection nor postoperative neurologic dysfunctions were detected. Clinical follow up excluded the presence of postoperative neuropathies. Triple monitoring showed to be a useful and feasible tool while performing IBPB for arthroscopic shoulder surgery. Future studies will be needed to confirm our findings.<\/jats:p>","DOI":"10.3390\/jcm10040781","type":"journal-article","created":{"date-parts":[[2021,2,16]],"date-time":"2021-02-16T04:23:10Z","timestamp":1613449390000},"page":"781","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":20,"title":["Triple Monitoring May Avoid Intraneural Injection during Interscalene Brachial Plexus Block for Arthroscopic Shoulder Surgery: A Prospective Preliminary Study"],"prefix":"10.3390","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5076-3693","authenticated-orcid":false,"given":"Giuseppe","family":"Pascarella","sequence":"first","affiliation":[{"name":"Unit of Anaesthesia, Intensive Care and Pain Management, Department of Medicine, Universit\u00e0 Campus Bio-Medico di Roma, Via \u00c1lvaro del Portillo 21, 00128 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alessandro","family":"Strumia","sequence":"additional","affiliation":[{"name":"Unit of Anaesthesia, Intensive Care and Pain Management, Department of Medicine, Universit\u00e0 Campus Bio-Medico di Roma, Via \u00c1lvaro del Portillo 21, 00128 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fabio","family":"Costa","sequence":"additional","affiliation":[{"name":"Unit of Anaesthesia, Intensive Care and Pain Management, Department of Medicine, Universit\u00e0 Campus Bio-Medico di Roma, Via \u00c1lvaro del Portillo 21, 00128 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefano","family":"Rizzo","sequence":"additional","affiliation":[{"name":"Unit of Anaesthesia, Intensive Care and Pain Management, Department of Medicine, Universit\u00e0 Campus Bio-Medico di Roma, Via \u00c1lvaro del Portillo 21, 00128 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5240-6131","authenticated-orcid":false,"given":"Romualdo","family":"Del Buono","sequence":"additional","affiliation":[{"name":"Unit of Anesthesia, Resuscitation, Intensive Care and Pain Management, ASST Gaetano Pini, P.zza A. Ferrari 1, 20122 Milano, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luigi Maria","family":"Remore","sequence":"additional","affiliation":[{"name":"Unit of Anaesthesia, Intensive Care and Pain Management, Department of Medicine, Universit\u00e0 Campus Bio-Medico di Roma, Via \u00c1lvaro del Portillo 21, 00128 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Federica","family":"Bruno","sequence":"additional","affiliation":[{"name":"Unit of Anaesthesia, Intensive Care and Pain Management, Department of Medicine, Universit\u00e0 Campus Bio-Medico di Roma, Via \u00c1lvaro del Portillo 21, 00128 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Felice Eugenio","family":"Agr\u00f2","sequence":"additional","affiliation":[{"name":"Unit of Anaesthesia, Intensive Care and Pain Management, Department of Medicine, Universit\u00e0 Campus Bio-Medico di Roma, Via \u00c1lvaro del Portillo 21, 00128 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2021,2,16]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"998","DOI":"10.1097\/ALN.0000000000001894","article-title":"Suprascapular and Interscalene Nerve Block for Shoulder Surgery","volume":"127","author":"Hussain","year":"2017","journal-title":"Anesthesiology"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"501","DOI":"10.1097\/ACO.0b013e328362d08a","article-title":"Standard approaches for upper extremity nerve blocks with an emphasis on outpatient surgery","volume":"26","author":"Kwofie","year":"2013","journal-title":"Curr. 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