Diffusion of contrast medium after perineural injection of the palmar nerves: An in vivo and in vitro study

Reasons for performing study: Proximal diffusion of local anaesthetic solution after perineural anaesthesia may lead to the desensitisation of structures other than those intended. However, there is no evidence‐based study demonstrating the potential distribution and diffusion of local anaesthetic solution after perineural analgesia in the distal limb. Objective: To document the potential diffusion of local anaesthetic solution using a radiopaque contrast model and to evaluate the influence of walking compared with confinement in a stable after injection. Methods: Radiopaque contrast medium was injected subcutaneously over one palmar nerve at the base of the proximal sesamoid bones in 6 nonlame mature horses. Horses were assigned randomly to stand still or walk after injection. Radiographs were obtained 0, 5, 10, 15, 20 and 30 min after injection and were analysed to determine the distribution and diffusion of the contrast medium. Results: In 89% of injections an elongated pattern of the contrast medium was observed suggesting distribution along the neurovascular bundle. After 49% of injections a fine radiopaque line extended proximally from the contrast ‘patch’, and in 25% of injections a line extended distally. There was significant proximal and distal diffusion with time when sequential radiographs of each limb were compared. The greatest diffusion occurred in the first 10 min. Walking did not significantly influence the extent of either proximal or distal diffusion. Conclusions and potential relevance: Significant proximal diffusion occurs in the first 10 min after perineural injection in the distal aspect of the limb and should be considered when interpreting nerve blocks. Distribution of local anaesthetic solution outside the fascia surrounding the neurovascular bundle or in lymphatic vessels may explain delayed or decreased effects.     

新疆塔里木河下游胡杨树高生长量及其空间分布研究

以塔里木河下游4个典型断面作为野外调查靶区,根据3a来对塔里木河下游胡杨恢复状况的实地监测数据,分析了影响胡杨树高生长量的因素,并得出中龄段胡杨树高生长量和地下水埋深的回归模型:y=-0.1286x+1.0097。结果显示:在塔里木河下游影响胡杨生长的主要因子是地下水,由回归模型可以得出:当地下水埋深<4.5m时,中龄胡杨树高生长是显著的;地下水埋深在4.5~6.5 m时,胡杨树高生长受到抑制;而当地下水埋深>6.5 m时,胡杨树高生长非常缓慢;地下水埋深>8m时,胡杨树高生长基本停止。此外,聚丛的群生株无论在树高还是在高生长量上都比散生的单生株显现优势。