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Open Access Highly Accessed Research article

Absence of neurotoxicity with perineural injection of ultrasound gels: assessment using an animal model

David Belavy1*, Nana Sunn2, Queenie Lau3 and Thomas Robertson3

Author affiliations

1 Burns, Trauma and Critical Care Research Centre, The University of Queensland, Royal Brisbane and Women’s Hospital, Butterfield Street, Herston, QLD 4029, Australia

2 The University of Queensland Diamantina Institute, Translational Research Institute Pty Ltd, Princess Alexandra Hospital, Level 6, 37 Kent St, Woolloongabba, QLD 4102, Australia

3 Department of Pathology, Royal Brisbane and Womens Hospital, Herston 4029, Australia

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Citation and License

BMC Anesthesiology 2013, 13:18  doi:10.1186/1471-2253-13-18

Published: 3 September 2013

Abstract

Background

Ultrasound gels may contain propylene glycol and glycerol, which are neurotoxic in high concentrations. If the needle passes through gel during regional anesthesia, gel may be injected near the nerve. It is unknown if this practice poses a risk for neurotoxicity. Using an animal model, we assessed the histological changes of perineural propylene glycol on nerves. We then assessed three commonly used sterile gels for evidence of neurotoxicity.

Methods

Micro-ultrasound guided perineural sciatic nerve injections were performed in mice. Propylene glycol (PG) 2.5%, 10%, 35%, 70% (v/v) or saline was injected. Nerves were assessed after three days for evidence of neurotoxicity. Aquasonic® 100 Ultrasound Gel, K-Y® Lubricating Jelly, and PDI® Lubricating Jelly were also studied against saline controls.

Results

Confluent areas of axonal degeneration and intraneural inflammation occurred in 5 of 9 specimens injected with 70% PG. At 35%, 2 of 8 specimens showed patchy changes not present at lower concentrations. No degeneration occurred with Aquasonic® 100 or PDI® Lubricating Jelly. In the K-Y® group, one gel and one saline specimen demonstrated confluent degenerative changes.

Conclusions

Similar to glycerol, 70% PG may cause confluent areas of axon and myelin degeneration with associated intraneural inflammation. The concentration of PG present in ultrasound gels is unlikely to cause neurotoxicity. Aquasonic® 100 and PDI® Lubricating Jelly did not cause neurotoxicity. The results for K-Y® Lubricating Jelly are inconclusive. There is no evidence that passing the needle through the studied gels during regional anesthesia procedures is harmful.

Keywords:
Ultrasound gel; Neurotoxicity; Regional anesthesia; Ultrasound; Animal models; Nerve injury