Complications of regional anesthesia: an overview.
Perhaps the clearest picture of the numbers and types of injuries from regional anesthesia is provided by the ASA Closed Claims Project database. In reviewing these data, it is valuable to keep in mind, of course, that the lack of a denominator makes the calculation of incidence impossible. For the decade of the 1990s, 308 claims were associated with regional anesthesia (versus 642 claims associated with general anesthesia). The percentage of these claims for patient death (10%) continued its steady decline from more than 20% in the 1970s and 13% in the 1980s. The primary reason for death remains cardiac arrest associated with neuraxial blockade, though this now represents only 30% of the deaths as opposed to 61% in the 1970s and 40% in the 1980s. There were 71 permanent disabling injuries among the 308 claims. The most common of these (23%) was associated with nerve blocks of the eye (13 retrobulbar, 3 peribulbar), and typically the injury entailed loss of vision. Second in frequency (21%) were pain-management related claims involving, for example, neuraxial opiates or neurolytic blocks. Third in frequency (20%) were nerve injuries associated with neuraxial and peripheral blocks followed by epidural hematomas (13%).
Ben-David
Bruce
B
University of Pittsburgh, Department of Anesthesiology, A 1305 Scaife Hall, 3550 Terrace Street, Pittsburgh, PA 15261, USA. b.bendavid@verizon.net
D000765:Anesthesia, Conduction / Q000009:adverse effects*; D016208:Databases, Factual; D006801:Humans; D007345:Insurance Claim Review; D009407:Nerve Block / Q000009:adverse effects; D010146:Pain / Q000523:psychology; D059408:Pain Management; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology; D014481:United States