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Disposable manometer for measuring peripheral nerve block injection pressures

B-Smart™ is the first disposable manometer for objective monitoring of injection pressure during administration of peripheral nerve blocks.

Resistance to injection is a part of standard documentation procedure during nerve blocks. Before B-Smart, documentation of the resistance was merely subjective and relied on the “learned feel” and experience of the provider.

Design Advantages

  • Take away the guess work: Provides a visual indication of injection pressure
  • Last line of defense: Monitoring a pressure in real-time provides objective information to make more informed decisions on how to proceed with an injection.
  • Objective documentation: An objective and quantifiable method of monitoring and documenting injection pressure regardless of who performs the injection.

Significance of High Injection Pressure

Intrafascicular injections at high pressures > 15 psi:

High injection pressures at the onset of injection may indicate an intraneural needle placement and lead to severe fascicular injury and persistent neurologic deficits.1

Needle-nerve contact and high pressures:

One study cites 97% detection of needle-nerve contact at ≥ 15 psi.2 Forceful needle-nerve contact and injection may result in intraneural inflammatory changes.3

Hand-feel: A Reliable Method?

How do you determine “high” pressure and is it consistent across all Providersand nurses?

The results of one study show that, “providers vary widely in their perception of appropriate force and rate of injection during PNB. The syringe-feel method of assessing injection force is inconsistent.”4 Of the 30 providers, “21 (70%) initiated injection using a force that resulted in pressures greater than 20 psi; 15 (50%) used a force greater than 25 psi, and 3 (10%) exerted pressures greater than 30 psi.”4

In another study, “providers were unable to correctly identify intraneural injection by syringe feel during simulated regional anesthesia.”5

  1. 1. Hadzic A, Dilberovic F, Shah S, Kulenovic A, Kapur E, Zaciragic A, Cosovic E, Vuckovic I, Divanovic K-A, Mornjakovic Z, Thys DM, Santos AC: Combination of intraneural injection and high injection pressure leads to fascicular injury and neurologic deficits in dogs. Reg Anesth Pain Med 2004; 29:417–23.
  2. 2. Gadsden JC, Choi JJ, Lin E, Robinson A: Opening Injection Pressure Consistently Detects Needle–Nerve Contact during Ultrasound-guided Interscalene Brachial Plexus Block: Anesthesiology 2014; 120:1246–53
  3. 3. Steinfeldt T, Poeschl S, Nimphius W, Graf J, Zoremba M, Mueller H-H, Wulf H, Dette F: Forced needle advancement during needle-nerve contact in a porcine model: histological outcome. Anesth. Analg. 2011; 113:417–20
  4. 4. Claudio R, Hadzic A, Shih H, Vloka JD, Castro J, Koscielniak-Nielsen Z, Thys DM, Santos AC: Injection pressures by anesthesiologists during simulated peripheral nerve block. Reg Anesth Pain Med 2004; 29:201–5
  5. 5. Theron PS, Mackay Z, Gonzalez JG, Donaldson N, Blanco R: An animal model of “syringe feel” during peripheral nerve block. Reg Anesth Pain Med 2009; 34:330–2

Contact a Representative

Please take a minute to complete the request form or call 1-800-227-2862 to contact a B. Braun representative. Thank you.



Product Identification
Product Code BS015-30
WSN Number 08021-0010-65
Reference Number BS015-30
Storage and Shipping
Total Shelf Life (Months) 060
Ordering Unit Case
Units per Case 275
Dimensions per Case 22.480 x 14.882 x 10.079 inches
Shipping Weight per Case 5.928 lb

Related Documents

Description Document Link
B-Smart™ Brochure
pdf (975.8 KB)
Pain Control Products Reference Guide
pdf (2.6 MB)
B-Smart™ IFU
pdf (104.2 KB)
Learn more about PNB Monitoring