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07 Jun

Differentiation between nerve and adipose tissue with optical spectroscopy was investigated in thyroid and parathyroid surgery by Schols et al. Discrimination between nerve and adipose tissue was possible especially when measuring the spectra in the near infrared region.However, due to the limited dataset of only including adipose tissue and nerve, no definitive conclusions could be drawn from this data regarding needle placement for regional anesthesia where the needle also traverses subcutaneous fat and muscle tissue.The results indicated that the transitions from muscle to nerve target region could be identified reliably.However, the question of nerve proximity remained unanswered.While promising results were presented, the study was limited to detecting a “nerve target region” and performed on only two swine. [] investigated optical detection of peripheral nerves in 20 patients.Subcutaneous fat, muscle and a nerve target region were the tissue types included and detected in the study.This study showed that spectral tissue sensing, based on diffuse reflectance spectroscopy at the needle tip, is a promising technique to discriminate fascicular tissue of the nerve from the surrounding tissues.The technique may therefore improve accurate needle placement near the nerve which is necessary for effective nerve blocks in regional anesthesia.] as well as a lower risk for delirium and nausea have been reported.

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Diffuse optical spectroscopy is a technique which sends white light into tissue and measures the reflected light.

Current disadvantages of regional anesthesia are the unpredictable onset time of the block as well as the risk of a failed block and, although rare, the risk for complications caused by injection of local anesthetics into critical structures such as blood vessels or nerve fascicles (see Fig.

Techniques like paresthesia, electrical nerve stimulation and ultrasound guidance have been introduced to improve needle placement.

The reflected light has a specific spectral distribution due to the absorption and scattering of photons interacting with the tissue.

Since these changes are determined by the tissue composition, the technique provides tissue discrimination.