Fascial “clicks” and “pops” are common during nerve block procedures, and sometimes can be useful for determining needle location. However, one must be careful when passing the needle through the fasciae. This is because the fasciae are typically tougher than the tissues in front or behind. Consequently, penetration of the fascia to place the needle close to the nerves or plexi requires some force. As the needle penetrates the fascia, the needle tends to advance uncontrollably after the fascia gives in. During the uncontrolled advancement, the needle may mechanically injure the nerves underneath the fascia.
In this video, Dr. Hadzic explains the role of fascia in nerve block-related injuries using NYSORA’s amazing Reverse Ultrasound Anatomy Animation of the interscalene brachial plexus and suggests methods to decrease the risk.
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