A convenient alternative for monitoring opening pressure during multiple needle redirection

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Abstract
Editor—Triple monitoring (ultrasound, nerve stimulator, and injection pressure) during nerve block has been proposed as the standard to minimize nerve injury.1 Ultrasound improves safety in nerve block, but it is relatively user-dependent and hard to differentiate between intra- or extra-fascicular injection by current resolution. Besides, the expert opinion did not reveal that high-definition ultrasound alone could be the answer for safe paraneural injection in popliteal sciatic nerve block in the future.2 On the contrary, ultrasound guidance seems to encourage multiple injection and small readjustment of needle tip position has been suggested to ensure local anaesthetic spread to all trunks for supraclavicular block.3 The effect of nerve stimulator might also be attenuated by previous local anaesthetic spread nearby. Therefore, once the needle has been redirected, monitoring ‘every’ opening pressure before local anaesthetic administration is the key to avoid intrafascicular injection, especially during performance of block within the nerve plexus or when the information about needle–nerve contact could not be confirmed. Half-the-air technique helps to keep injection pressure below 15 psi,4 from which we provide an easy, convenient, and inexpensive setting to monitor opening pressure during multiple needle redirection.

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