title: [Peripheral regional anesthesia in patients under general anesthesia: risk assessment with respect to parasthesia, injection pain and nerve damage].
abstract: Nerve injury after peripheral regional anesthesia is rare and is not usually permanent. Some authors believe that inducing peripheral nerve blocks in patients during general anesthesia or analgosedation adds an additional risk factor for neuronal damage. This is based on published case reports showing that there is a positive correlation between paresthesia experienced during regional anesthesia and subsequent nerve injury. Therefore, many sources recommend that regional nerve blocks should only be performed in awake or lightly sedated patients, at least in adults. However, there is no scientific basis for this recommendation. Furthermore, there is no proof that regional anesthesia performed in patients under general anesthesia or deep sedation bears a greater risk than in awake or lightly sedated patients. Currently anesthesiologists are free to follow personal preferences in this matter as there is no good evidence favoring one approach over the other. The risk of systemic toxicity of local anesthetic agents is not higher in patients who receive regional anesthesia under general anesthesia or deep sedation. Finally, in children and uncooperative adults the administration of peripheral nerve blocks under general anesthesia or deep sedation is widely accepted.
authors.affiliation: Abteilung für Anästhesiologie, Intensiv- und Schmerzmedizin, Orthopädische Universitätsklinik Friedrichsheim gGmbH, Marienburgstr. 2, 60528 Frankfurt, Deutschland. p.kessler@friedrichsheim.de
authors.forename: P
authors.initials: P
authors.lastname: Kessler
authors.forename: T
authors.initials: T
authors.lastname: Steinfeldt
authors.forename: W
authors.initials: W
authors.lastname: Gogarten
authors.forename: U
authors.initials: U
authors.lastname: Schwemmer
authors.forename: J
authors.initials: J
authors.lastname: Büttner
authors.forename: B M
authors.initials: BM
authors.lastname: Graf
authors.forename: T
authors.initials: T
authors.lastname: Volk
mesh_terms: D000328:Adult; D000765:Anesthesia, Conduction / Q000379:methods*; D000768:Anesthesia, General / Q000379:methods*; D000779:Anesthetics, Local / Q000008:administration & dosage / Q000009:adverse effects; D002648:Child; D054810:Deep Sedation; D006801:Humans; D007267:Injections / Q000009:adverse effects; D009407:Nerve Block; D010146:Pain / Q000209:etiology*; D010292:Paresthesia / Q000139:chemically induced*; D059348:Peripheral Nerve Injuries / Q000139:chemically induced*; D018570:Risk Assessment
chemical_list: D000779:Anesthetics, Local