Case report: Neurological deficit associated with intraneural needle placement without injection

Purpose

Recent reports of painless intraneural injection of low volumes of local anesthetic without subsequent neurological deficit have led to the suggestion that deliberate subepineural injection may be a safe and therefore acceptable practice.

Clinical features

This report describes a case where a venous cannulation needle inadvertently penetrated a patient’s median nerve. Sudden onset severe lancinating pain occurred in the median nerve sensory distribution. A subsequent thorough ultrasound examination showed the median nerve to be located immediately posterior to the targeted median cubital vein. New onset sensory symptoms (numbness, tingling, pain, and altered sensation to touch) in the distribution of the penetrated median nerve persisted for >6 weeks.

Conclusion

This report highlights the hazards of intraneural needle placement irrespective of an associated injection.