Incidence of Subclinical Neuropathy after Intraneural Injection
Bibliographic record
Abstract
To the Editor: We read with interest the recent article by Sala-Blanch et al. 1, in which the authors prospectively evaluated the frequency of subclinical neurologic injury following nerve-stimulator-guided low-pressure intraneural injection of local anesthetic and radio-opaque contrast for a single-shot sciatic popliteal bock in 16 patients undergoing hallux valgus repair. Intraneural injection was confirmed by ultrasound and computed tomography scan imaging. Patients underwent physical examination and conventional electrophysiologic studies both preoperatively and postoperatively at weeks 1 and 4 to detect clinical and subclinical nerve injury, respectively. None of the 16 patients demonstrated evidence of clinical or subclinical nerve injury. Based on these results, the authors cautiously concluded that low-pressure intraneural injection within the sciatic nerve at the popliteal level may not result in clinical or subclinical nerve injury. Despite material differences in methodology, Sala-Blanch et al. 's findings are in stark contrast to a recent publication that reported the frequency of subclinical nerve injury after nerve-stimulator-guided continuous femoral nerve block in young adults undergoing anterior cruciate ligament repair to be 24% at 4 weeks, based on clinical examination and conventional electrophysiologic study2; all patients recovered at 6 months.Therefore, we believe that some additional information is necessary in order for the readership, ourselves included, to meaningfully interpret the clinical relevance of the present results. First, the authors defined electrophysiologic nerve injury as “a change in latency (more than 120%) or in amplitude and conduction velocity (less than 80%) compared with baseline data obtained in the same individual.” However their table 3 summarizes the mean electrophysiologic records for all the patients at the three time-points. Averaging theses values may mask potential electrophysiologic variations, which may occur following nerve injury. We believe the raw electrophysiologic data for each patient both at baseline and at 4 weeks postoperatively should also be reported, as the evolution over time may further inform our understanding of nerve injury. Indeed, the value of electrodiagnostic data at 1 week postoperatively may be questionable, as motor and sensory axons can remain excitable for a period of 7 and 11 days, respectively, following an insult.3Nonetheless, the results of Sala-Blanch et al. 's study do seem to lend support to the growing body of important literature suggesting that intraneural injection may not always lead to nerve injury, and for this, we are sincerely grateful.
Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.
How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.003 | 0.021 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.003 | 0.002 |
| Open science | 0.003 | 0.001 |
| Research integrity | 0.008 | 0.007 |
| Insufficient payload (model declined to judge) | 0.001 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".