Regional Nerve Blocks-Best Practice Strategies for Reduction in Complications and Comprehensive Review

Curr Pain Headache Rep. 2019 May 23;23(6):43. doi: 10.1007/s11916-019-0782-0.

Abstract

Purpose of review: Understanding the etiologies of the complications associated with regional anesthesia and implementing methods to reduce their occurrence provides an opportunity to foster safer practices in the delivery of regional anesthesia.

Recent findings: Neurologic injuries following peripheral nerve block (PNB) and neuraxial blocks are rare, with most being transient. However, long-lasting and devastating sequelae can occur with regional anesthesia. Risk factors for neurologic injury following PNB include type of block, injection in the presence of deep sedation or general anesthesia, presence of existing neuropathy, mechanical trauma from the needle, pressure injury, intraneural injection, neuronal ischemia, iatrogenic injury related to surgery, and local anesthetic neurotoxicity. The present investigation discusses regional blocks, complications of regional blocks, risk factors, site-specific limitations, specific complications and how to prevent them from happening, avoiding complications in regional anesthesia, and the future of regional anesthesia.

Keywords: Analgesia; Nerve blocks; Pain; Regional anesthesia; Ultrasound.

Publication types

  • Review

MeSH terms

  • Anesthesia, Conduction / adverse effects
  • Anesthesia, Conduction / standards*
  • Anesthetics, Local / administration & dosage*
  • Anesthetics, Local / adverse effects
  • Humans
  • Nerve Block / adverse effects
  • Nerve Block / standards*
  • Pain / drug therapy
  • Peripheral Nervous System Diseases / chemically induced
  • Peripheral Nervous System Diseases / etiology
  • Peripheral Nervous System Diseases / prevention & control*
  • Practice Guidelines as Topic / standards*

Substances

  • Anesthetics, Local