Citations

Background and Objectives Successful regional anesthesia involves a three-dimensional visualization of anatomy and an informed approach to needle placement and repositioning. This study trigonometrically examines the relationship between needle insertion angle and resultant needle position. Methods Needle position during advancement of 2-inch (5.1-cm), 3 ½-inch (8.9-cm), and 5-inch (12.7-cm) needles was trigonometrically determined. Starting at 90°, the angle of needle insertion θ (measured from the perpendicular) was decreased in 5° and 10° increments, and the resultant change in needle position was calculated by using a computer model. Needle depths relevant to the three needle lengths were studied and ranged from 0.5 to 11.0 cm. The effects of needle insertion angle, redirection angle, and depth on resultant needle position were evaluated. Results The mean change in needle position was significantly less with a 5° redirection of the needle than with a 10° needle redirection. In addition, the mean change in needle position was highly correlated with increasing needle depth and acute angle of needle insertion. Conclusions Incremental needle redirection of 5° allows a precise survey of neural and adjacent anatomy and results in approximately one half the change in needle position occurring with a 10° angle of redirection. However, a 10° angle of redirection may result in walking over the desired neural structure.

Morphine sulfate, a narcotic analgesic, possesses the undesirable side effects of central depression, tolerance, and dependency. Opiate receptors have been found in the brain and the spinal cord. Intrathecally applied opiates produce potent analgesia that can be antagonized by naloxone. The time-response study with tail-flick response after intrathecal injections of a small dosage of morphine (25 μg) demonstrated a long-lasting analgesia. Intrathecal injections of morphine or opiate-like peptides may become a predictable modality of pain relief without attendant loss of other neurologic function.