Using the BBraun BSmartTM Pressure Manometer to Prevent Unsafe Injection Pressures During Simulated Peripheral Nerve Blockade: A Pilot Study

Rebecca L. Smith1, *, Simeon J. West2, Jason Wilson3
1 Magill Department of Anaesthesia, Chelsea and Westminster Trust, 369 Fulham Road, London, SW10 9NH, UK
2 Department of Anaesthesia and Perioperative Medicine, University College Hospital, 235 Euston Road, London, NW1 2BU, UK
3 Department of Anaesthesia, Imperial College London, Charing Cross Hospital, Fulham Palace Road, London, W6 8RF, UK

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Creative Commons License
© 2021 Smith et al.

open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International Public License (CC-BY 4.0), a copy of which is available at: This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

* Address correspondence to this author at Magill Department of Anaesthesia, Consultant Anaesthetist, Chelsea and Westminster Trust, 369 Fulham Road, SW10 9NH, London: UK; Tel: 0203 315 6666; E-mail:



Peripheral nerve injury during regional anaesthesia may result from accidental intraneural placement of the needle, or forceful needle nerve contact. Intraneural injections are associated with increased resistance to injection, typically >15 psi. The BBraun BSmart™ is an inline mechanical manometer, offering a visual display of injection pressures.


The primary objective of this study was to determine if using the BBraun BSmartTM manometer successfully prevents 90% of anaesthetists and anaesthetic assistants from injecting at pressures > 15 psi during simulated nerve block.


This was a prospective observational study involving anaesthetists and anaesthetic assistants. Two 20 ml injections were performed by each participant, once when the BBraun BSmartTM manometer was obscured from view, and once with the manometer visible. A PendoTech PressureMATTMS recorded injection pressures.


39 participants completed the study, with a total of 78 injections recorded. During the study, 32 peak pressures during the 78 procedures were recorded above the recommended upper limit of 15 psi, 41% of the total injections. The peak pressure rose above 15 psi in 24/39 (62%) injections when the BBraun Bsmart™ manometer was obscured, but only in 8/39 (21%) injections when the manometer was visible.


The BBraun Bsmart™ manometer did not successfully prevent 90% of anaesthetists or anaesthetic assistants from injecting at unsafe pressures. However, using the BBraun BSmart™ did reduce the number of unsafe injection pressures generated by participants. When utilised in conjunction with PNS and ultrasound guidance, this may offer additional safety during peripheral nerve blockade.

Keywords: BBraun BSmartTM, Intraneural injection, Peripheral nerve block, Anaesthetists, Mechanical manometer, Injections.