B. Braun Medical, the market leader in Regional Anaesthesia (RA),announced that it will become the exclusive US distributor of the BSmart injection pressure monitor for peripheral nerve blocks (PNBs) from Concert Medical, LLC. BSmart is the first disposable monitor for measuring of injection pressure during administration of PNBs.

“We want to be the customer’s first choice for delivering RA safely and effectively,” said Joe Cleary, group product director of pain control marketing at B.Braun. “In the coming months, B.Braun will highlight ways to integrate complementary monitoring modalities (injection pressure, ultrasound and stimulation) and share the benefits. We call it ISM, or Injection Safety Monitoring,” added Cleary.

Practitioners already document resistance to injection, however, objective pressure monitoring is a relatively new concept.

“Monitoring a clinically relevant and objective pressure in real-time may help prevent an injection into a fascicle or against the epineurium before it occurs,” said Jeff Gadsden MD, Associate Professor of Anaesthesiology at Duke University. “We know in canine sciatic nerves that intraneural needle placement and high injection pressure lead to severe fascicular injury and persistent neurological deficits. We also know that objective pressure monitoring reliably detects needle-nerve contact at 15 psi in 97 per cent of cases in patients undergoing interscalene plexus block. This is relevant as initiation of flow against the epineurium may result in an intraneural injection or nerve inflammation, and consequent nerve damage,” Dr Gadsden added.

In the past, documentation of the resistance was subjective and relied on the “learned feel” and experience of the provider.

“When injection pressure matters, an objective and quantifiable method of monitoring and documenting injection pressure has the potential to provide more assurance than the subjective syringe-hand-feel technique. When anaesthesia providers were asked to perform a simulated injection using a syringe and needle assembly, the perception of appropriate force (pressure) and rate of injection varied widely. These findings indicate that the syringe–feel method of assessing injection force is inconsistent. Furthermore, in a nerve block simulation utilising actual animal tissue, practitioners were unable to correctly identify intraneural injection by syringe–feel technique,” added Dr. Gadsden.