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Possible intraneural injection — FRCA Final MCQ

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ModerateRegional AnaesthesiaPossible intraneural injectionFRCA Final

A 31-year-old woman has an ultrasound-guided axillary block for wrist fixation. During injection, the patient reports severe pain radiating down the forearm and the ultrasound image no longer shows the needle tip clearly. What is the most important next step?

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Correct answer: E — Stop injecting and reposition the needle under direct view

Pain on injection with loss of needle-tip visualisation raises concern for intraneural injection or unsafe needle placement. Injection should stop immediately and the needle should be repositioned with the tip visualised. Sedation may mask warning symptoms and increase risk. Ultrasound-guided regional anaesthesia is safest when injection occurs with clear needle-tip and spread visualisation.

Reference: RA-UK ultrasound-guided regional anaesthesia safety recommendations