Regional Anesthesia in Patients With Preexisting Neurologic Disease (original) (raw)
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Regional Anesthesia and Pain Medicine, 2015
Neurologic injury associated with regional anesthetic or pain medicine procedures is extremely rare. The Second American Society of Regional Anesthesia and Pain Medicine Practice Advisory on Neurologic Complications Associated With Regional Anesthesia and Pain Medicine focuses on those complications associated with mechanical, ischemic, or neurotoxic injury of the neuraxis or peripheral nervous system. As with the first advisory, this iteration does not focus on hemorrhagic or infectious complications or local anesthetic systemic toxicity, all of which are the subjects of separate practice advisories. The current advisory offers recommendations to aid in the understanding and potential limitation of rare neurologic complications that may arise during the practice of regional anesthesia and/or interventional pain medicine.
Neurological Complications After Regional Anesthesia: Contemporary Estimates of Risk
Anesthesia & Analgesia, 2007
BACKGROUND: Regional anesthesia (RA) provides excellent anesthesia and analgesia for many surgical procedures. Anesthesiologists and patients must understand the risks in addition to the benefits of RA to make an informed choice of anesthetic technique. Many studies that have investigated neurological complications after RA are dated, and do not reflect the increasing indications and applications of RA nor the advances in training and techniques. In this brief narrative review we collate the contemporary investigations of neurological complications after the most common RA techniques. METHODS: We reviewed all 32 studies published between January 1, 1995 and December 31, 2005 where the primary intent was to investigate neurological complications of RA. RESULTS: The sample size of the studies that investigated neurological complications after central and peripheral (PNB) nerve blockade ranged from 4185 to 1,260,000 and 20 to 10,309 blocks, respectively. The rate of neuropathy after spinal and epidural anesthesia was 3.78:10,000 (95% CI: 1.06-13.50:10,000) and 2.19:10,000 (95% CI: 0.88-5.44:10,000), respectively. For common PNB techniques, the rate of neuropathy after interscalene brachial plexus block, axillary brachial plexus block, and femoral nerve block was 2.84:100 (95% CI 1.33-5.98:100), 1.48:100 (95% CI: 0.52-4.11:100), and 0.34:100 (95% CI: 0.04-2.81:100), respectively. The rate of permanent neurological injury after spinal and epidural anesthesia ranged from 0-4.2:10,000 and 0-7.6:10,000, respectively. Only one case of permanent neuropathy was reported among 16 studies of neurological complications after PNB. CONCLUSIONS: Our review suggests that the rate of neurological complications after central nerve blockade is <4:10,000, or 0.04%. The rate of neuropathy after PNB is <3:100, or 3%. However, permanent neurological injury after RA is rare in contemporary anesthetic practice.
ASRA practice advisory on neurologic complications in regional anesthesia and pain medicine
Regional anesthesia …, 2008
Neurologic complications associated with regional anesthesia and pain medicine practice are extremely rare. The ASRA Practice Advisory on Neurologic Complications in Regional Anesthesia and Pain Medicine addresses the etiology, differential diagnosis, prevention, and treatment of these complications. This Advisory does not focus on hemorrhagic and infectious complications, because they have been addressed by other recent ASRA Practice Advisories. The current Practice Advisory offers recommendations to aid in the understanding and potential limitation of neurologic complications that may arise during the practice of regional anesthesia and pain medicine.
Complications of Regional Anesthesia and Acute Pain Management
Anesthesiology Clinics, 2011
Perioperative nerve injuries have long been recognized as a complication of regional anesthesia. Fortunately, severe or disabling neurologic complications rarely occur. Risk factors contributing to neurologic deficit after regional anesthesia include neural ischemia (hypothetically be related to the use of vasoconstrictors or prolonged hypotension), traumatic injury to the nerves during needle or catheter placement, infection, and choice of local anesthetic solution. 1-4 In addition, postoperative neurologic injury due to pressure from improper patient positioning or from tightly applied casts or surgical dressings, as well as surgical trauma, are often attributed to the regional anesthetic. 5 Lynch and colleagues 6 reported a 4.3% incidence of neurologic complications following total shoulder arthroplasty. The neurologic deficit localized to the brachial plexus in 75% of affected patients. Importantly, the level of injury occurred most commonly at the upper and middle nerve trunks-the level at which an interscalene block is performed, making it impossible to determine the cause of the nerve injury (surgical vs anesthetic). Patient factors such as body habitus or a preexisting neurologic condition may also contribute. 7-9 For example, the incidence of peroneal nerve palsy following total knee replacement is increased in patients with significant valgus or a preoperative neuropathy and the severity is increased in patients receiving epidural analgesia (Table 1). 10,11 The safe conduct of neuraxial anesthesia involves knowledge of the large patient surveys as well as individual case reports of neurologic deficits following neural blockade. Prevention of complications, along with early diagnosis and treatment are important factors in management of regional anesthetic risks. INCIDENCE OF NEUROLOGIC COMPLICATIONS Although severe or disabling neurologic complications are rare, recent epidemiologic series suggest the frequency of some serious complications is increasing. A