Complications associated with eye blocks and peripheral nerve blocks: an american society of anesthesiologists closed claims analysis.
OBJECTIVE
Concern for block-related injury and liability has dissuaded many anesthesiologists from using regional anesthesia for eye and extremity surgery, despite many studies demonstrating the benefits of regional over general anesthesia. To determine injury patterns and liability associated with eye and peripheral nerve blocks, we re-examined the American Society of Anesthesiologists Closed Claims Database as part of the American Society of Regional Anesthesia and Pain Medicine's Practice Advisory on Neurologic Complications of Regional Anesthesia and Pain Medicine.


METHODS
Claims with eye or peripheral nerve blocks performed perioperatively from 1980 through 2000 were analyzed. The liability profile of anesthesiologists who provided both the eye block and sedation for eye surgery was compared with the profile of anesthesiologists who provided sedation only. The injury patterns associated with peripheral nerve blocks and payment factors were analyzed.


RESULTS
Anesthesiologists who provided both the eye block and sedation for eye surgery (n = 59) had more injuries associated with block placement (P < .001), a higher proportion of claims with permanent injury (P < .05), and a higher proportion of claims with plaintiff payment (P < .05), compared with anesthesiologists who provided sedation only (n = 38). Peripheral nerve blocks (n = 159) were primarily associated with temporary injuries (56%). Local anesthetic toxicity was associated with 7 of 19 claims with death or brain damage.


CONCLUSIONS
Performance of eye blocks by anesthesiologists significantly alters their liability profile, primarily related to permanent eye damage from block needle trauma. Though most peripheral nerve block claims are associated with temporary injuries, local anesthetic toxicity is a major cause of death or brain damage in these claims.
Lee
Lorri A
LA
Department of Anesthesiology, University of Washington, Seattle, WA, USA. lorlee@u.washington.edu <lorlee@u.washington.edu>
Posner
Karen L
KL
Cheney
Frederick W
FW
Caplan
Robert A
RA
Domino
Karen B
KB
D000368:Aged; D000772:Anesthesia, Local / Q000009:adverse effects*; D000779:Anesthetics, Local / Q000506:poisoning; D005260:Female; D006801:Humans; D015601:Injury Severity Score; D007345:Insurance Claim Review / Q000706:statistics & numerical data*; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009407:Nerve Block / Q000009:adverse effects*; D013508:Ophthalmologic Surgical Procedures / Q000009:adverse effects* / Q000379:methods; D059348:Peripheral Nerve Injuries; D012955:Societies, Medical; D014481:United States
D000779:Anesthetics, Local