Long-term neurological complications associated with surgery and peripheral nerve blockade: outcomes after 1065 consecutive blocks.
Peripheral nerve blockade is gaining popularity as an analgesic option for both upper or lower limb surgery. Published evidence supports the improved efficacy of regional techniques when compared to conventional opioid analgesia. The incidence of neurological deficit after surgery associated with peripheral nerve block is unclear. This paper reports on neurological outcomes occurring after 1065 consecutive peripheral nerve blocks over a one-year period from a single institution. All patients receiving peripheral nerve blocks for surgery were prospectively followed for up to 12 months to determine the incidence and probable cause of any persistent neurological deficit. Formal independent neurological review and testing was undertaken as indicated. Thirteen patients reported symptoms that warranted further investigation. A variety of probable causes were identified, with peripheral nerve block being implicated in two cases (one resolved at nine months and one remaining persistent). Overall incidence of block-related neuropathy was 0.22%. Persistent postoperative neuropathy is a rare but serious complication of surgery associated with peripheral nerve block. Formal follow-up of all such blocks is recommended to assess causality and allow for early intervention.
Watts
S A
SA
Department of Anaesthesia, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia.
Sharma
D J
DJ
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001315:Australia; D005260:Female; D005267:Femoral Nerve; D005500:Follow-Up Studies; D006801:Humans; D035002:Lower Extremity / Q000601:surgery; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D009407:Nerve Block / Q000009:adverse effects* / Q000379:methods; D017063:Outcome Assessment, Health Care / Q000379:methods / Q000706:statistics & numerical data; D010146:Pain / Q000209:etiology*; D059408:Pain Management; D010292:Paresthesia / Q000209:etiology* / Q000628:therapy; D010525:Peripheral Nerves; D010523:Peripheral Nervous System Diseases / Q000209:etiology* / Q000628:therapy; D011446:Prospective Studies; D012584:Sciatic Nerve; D013997:Time Factors; D034941:Upper Extremity / Q000601:surgery