[Safety and effectiveness of the cervical paravertebral approach to the brachial plexus--data from the Regional Anesthesia Surveillance System (RASS)].
BACKGROUND
This is the first report of the Regional Anesthesia Surveillance System (RASS) analyzing complication data of the relatively new cervical posterior approach to the brachial plexus.


METHODS
The Regional Anesthesia Surveillance System (RASS) was introduced in October 2003. All regional anesthesia punctures and continuous catheters in place are recorded as part of the midnight-statistic and forwarded to the RASS databank. Complications are registered and coded according to standardized definitions ( www.UIRASS.com ) by the acute pain service. Plausibility of coding is checked against the medical record by the RASS-coordinator for data quality assurance.


RESULTS
From October 2003-October 2005 there have been 360 cervical posterior punctures and 547 catheterdays. The utilization ratio of the cervical posterior brachial plexus block is 1.42 %. A pneumothorax occurred in 2.7/1000 punctures, local anesthetic toxicity and short term neurologic deficits were also observed in 2.7/1000 punctures. Catheter dislocation occurred in 5.4/1000 catheterdays and severe neck pain was noticed in 16.3/1000 punctures. There were no catheter associated long term neurological deficits, bleeding or infectious complications.


CONCLUSIONS
The cervical posterior approach to the brachial plexus is an alternative to the interscalene approach with the advantages of high success rate and secure catheter placement. Neck pain can be a disadvantage of the technique and acute complications like pneumothorax and local anesthetic toxicity seem to be similar to those reported with interscalene blocks in the literature.
Schulz-Stübner
S
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Department of Anesthesia, University of Iowa Hospitals and Clinics, Iowa City, Iowa 52242-1079, USA. Sebastian-schulz-stubner@uiowa.edu
D001917:Brachial Plexus; D002404:Catheterization / Q000706:statistics & numerical data*; D015897:Comorbidity; D005858:Germany / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D019547:Neck Pain / Q000453:epidemiology*; D009407:Nerve Block / Q000706:statistics & numerical data*; D011030:Pneumothorax / Q000453:epidemiology*; D011159:Population Surveillance; D012042:Registries; D018570:Risk Assessment / Q000379:methods; D012307:Risk Factors