Complications Of Regional Anesthesia Research Articles

Local Anesthetic Systemic Toxicity in Pregnancy: A Retrospective Cohort Analysis.

Introduction Local anesthetic systemic toxicity (LAST) is a rare complication of regional anesthesia. Pregnancy is a risk factor due to gestational physiologic changes. Labor and disorders of pregnancy can mask or delay symptoms of LAST, slowing appropriate intervention. This study examines LAST within a larger cohort and identifies features that help distinguish LAST in pregnant women from LAST in nonpregnant patients. Methods The TriNetX database was used to compare pregnant and nonpregnant patients with LAST from 2013 to 2023. Cohorts were matched on age, race, obesity status, diabetes, metabolic disorders, local anesthetic type, and cardiovascular, liver, kidney, and respiratory disease. Outcomes included prodromal symptoms of LAST and symptoms of cardiac and central nervous system excitation and depression. Results Matching occurred for 276 pregnant and 276 nonpregnant patients. Pregnant cohorts had a significantly higher risk of cardiac depression (risk ratio (RR)=1.96 (95% confidence interval (CI): 1.44-2.66), p<0.01) and significantly lower risk of cardiac excitation (RR=0.38 (95% CI: 0.22-0.63), p<0.01), prodromal symptoms (RR=0.17 (95% CI: 0.09-0.33), p<0.01), central nervous system excitation (RR=0.44 (95% CI: 0.21-0.90), p=0.02), and central nervous system depression (RR=0.24 (95% CI: 0.13-0.48), p<0.01) than nonpregnant cohorts. Conclusion Pregnant patients with LAST were more likely to exhibit cardiac depression and less likely to manifest prodromal symptoms, cardiac excitation, and central nervous system excitation and depression than nonpregnant patients. Physiological changes during pregnancy and prompt detection and treatment may explain these differences. These findings highlight the variable nature of LAST and how pregnancy may influence its clinical presentation.

Brainstem Anesthesia after Retrobulbar Anesthesia in Cataract Surgery: A Case Report

Brain-stem anesthesia is a serious and rare complication of orbital regional anesthesia that may occur when the local anesthetic agent gains access to the central nervous system via a direct spread from the apex of the orbit or the submeningeal pathways. We report the case of a 66 -year-old man who developed, after a retro-bulbar block for cataract surgery, a tonico-clonic seizures, hypotension and bradycardia-features of brainstem anesthesia. We present the clinical features, treatment and comments on how to prevent the problem. Although it is rare, and because it may be life-threatening in some cases, physicians who perform retrobulbar block should be aware of its features and various clinical manifestation in order to recognize and treat it. Also, facilities where ophtalmic surgery under local anesthesia are performed should be properly equiped in order to manage this complication.

Postoperative neurological symptoms following arthroscopic shoulder surgery with interscalene block: an exploratory secondary analysis of pooled randomized controlled trial data

ObjectivePostoperative neurological symptoms (PONS) are recognized complications of regional anesthesia and orthopedic surgery. We aimed to better characterize prevalence and potential risk factors in a homogeneous population of randomized, controlled...

Public Awareness and Knowledge About Anesthesiology and the Role of Anesthesiologists in Al-Qassim Province, Saudi Arabia.

Introduction Anesthesiology is a specialty of medicine that focuses on inducing reversible loss of consciousness, amnesia, muscle relaxation, and analgesia. Anesthesiologists play an important and integral role in pain clinics, operating rooms, and intensive care units (ICU). This study assessed public awareness and knowledge about the specialty of anesthesiology and the role of anesthesiologists in Qassim province, Saudi Arabia. Methods An observational, cross-sectional study was conducted in Qassim province from September 2022 to December 2022. A modified electronic questionnaire was distributed through social media platforms. The questionnaire contained items designated as demographics, knowledge, and experience regarding anesthesia and the importance of anesthesiologists. Saudi participants older than 18 years of age were eligible to complete the survey. Results Of the 405 participants, 375 met the inclusion criteria (48.5% women and 51.5% men), and participants with an undergraduate education level (23.5%, p<.05) had a higher prevalence of having undergone surgery previously. Furthermore, it was found that factors, such as knowledge about the complications of regional anesthesia (p<.001) positively influenced anesthesia knowledge. Moreover, in a linear regression model, an understanding of the complications of regional anesthesia was associated with increased anesthesia knowledge (p<.05). However, the sample demonstrated a poor level of anesthesia knowledge, evidenced by the responses to questions assessing the same. Conclusions Consistent with the literature, there was a poor level of anesthesia awareness and knowledge among the adult population living in Saudi Arabia. Further research is needed to establish the link between anesthesia awareness, knowledge about the role of the anesthesiologist, and knowledge about anesthesiology in the region.

Regional Anesthesia for Spine Surgery.

Current advancements in spine surgery have led to a recent interest in regional anesthesia for spine surgery. Spinal anesthesia, epidural anesthesia, and their combination are commonly used modalities for regional anesthesia in spine surgeries. The successful use of regional anesthesia has led to the emergence of several new concepts such as awake spinal fusion and outpatient spinal surgery. Regarding analgesic techniques, several new modalities have been described recently such as erector spinae and thoracolumbar interfascial plane blocks. These regional analgesic modalities are aimed at decreasing perioperative pain and enhancing early recovery in patients undergoing spine surgery. This narrative review focuses on the techniques, indications and contraindications, benefits, and complications of regional anesthesia in the context of spine surgery.

PRO AND CONTRA ON ADJUVANTS TO NEUROAXIAL ANESTHESIA AND PERIPHERAL NERVE BLOCKS.

Modern approach in surgical treatment and in managing acute and chronic pain is nowadays more and more based on the implementation of all possible techniques of regional anesthesia (RA). Local anesthetics (LA) are needed to achieve standard regional anesthesia. Local anesthetics are primarily characterized by time constraints and duration of action, and depending on the amount applied, adverse effects on the cardiac and central nervous system may occur. Adjuvants are drugs used together with LA due to their synergistic effect, i.e. they improve start latency and duration of sensory and motor blockade and enable reduction of cumulative dose of LA and reduction of adverse effects on cardiac and nervous system. Nowadays, there is a huge variety of drugs that can be administered in combination with LA, and they, in general, can be divided into opioid and non-opioid adjuvants. The administration of opioids in RA over an extended time period was accompanied by some negative characteristics as respiratory depression, nausea, vomiting. So, their usage is still under a special control. Due to the positive effects shown by drugs from non-opioid adjuvants group (e.g. adrenaline, alpha adrenergic agonists, steroids, magnesium, midazolam, ketamine etc.), indications for their administration broadened. However, there are still some restrains in clinical practice based on the fact that neurotoxicity and demonstration of neurological complications in regional anesthesia haven't been properly researched yet.

An evaluation of regional anesthesia complications and patient satisfaction after cesarean section

Background/Aim: In obstetric anesthesia, regional techniques are considered advantageous for maternal mortality and morbidity. Nevertheless, serious or less severe complications related to regional anesthesia may occur. This study aimed to determine the postoperative early complications and assess postoperative pain and satisfaction of the patients by conducting a postoperative survey among those operated with regional anesthesia on the day after cesarean section. Methods: All patients who underwent a cesarean section with regional anesthesia during the day within six months at our institution were considered for eligibility to participate in this cross-sectional study. On the day after the surgery, an anesthesiologist visited the patients and collected postoperative data, including demographic data and previous anesthesia experience, presence and intensity of the pain (current and from the operation until the postoperative visit), postoperative analgesia method, postoperative nausea, and vomiting (PONV), urinary catheterization, gas discharge, presence of backache, headache, shoulder pain, and initiation and the difficulties of breastfeeding. The patients were also questioned about their comfort during the operation, and their satisfaction with the anesthetic technique used. Results: A total of 729 patients participated in the survey. Postoperative pain was managed with paracetamol and non-steroidal anti-inflammatory drugs in 696 (95.5%) patients, PCEA in 25 (3.4%) patients and intravenous PCA in 8 (1.1%) patients. Six hundred and ninety-three (87.7%) patients had pain at the time of the visit and the mean VAS score of current pain intensity was 4.2 (1.7). Seven hundred and twenty-two (99.0%) patients had pain between the end of the operation until the postoperative visit and the mean VAS score of maximum pain intensity was 6.4 (2.0). The mean time until postoperative pain began was 3.7 (2.4) hours. Among all, 48.7% of the patients experienced backache, 36.9% had shoulder pain, 17.8% had postoperative nausea, 6.6% had postoperative vomiting, and 20.2% had a postpartum headache. Breastfeeding was not initiated until the first postoperative day in 87.5% of the patients and the mean time until the onset of breastfeeding was 1.9 (2.8) hours. The intraoperative comfort and satisfaction with the anesthesia method were rated as good/very good by 74.7% and 84.4% of our patients, respectively. Conclusion: Backache and shoulder pain are the most frequent minor complications in patients operated with regional anesthesia on the day after cesarean section. Determining and overcoming postoperative early complications is important for the satisfaction of patients after cesarean section.

Assessment of main complications of regional anesthesia recorded in an acute pain unit in a tertiary care university hospital: a retrospective cohort

BackgroundRegional anesthesia has been increasingly used. Despite its low number of complications, they are associated with relevant morbidity. This study aims to evaluate the incidence of complications after neuraxial block and peripheral nerve block. MethodsA retrospective cohort study was conducted, and data related to patients submitted to neuraxial block and peripheral nerve block at a tertiary university hospital from January 1, 2011 to December 31, 2017 were analyzed. ResultsFrom 10,838 patients referred to Acute Pain Unit, 1093(10.1%) had side effects or complications: 1039 (11.4%) submitted to neuraxial block and 54 (5.2%) to peripheral nerve block. The most common side effects after neuraxial block were sensory (48.5%) or motor deficits (11.8%), nausea or vomiting (17.5%) and pruritus (8.0%); The most common complications: 3 (0.03%) subcutaneous cell tissue hematoma, 3 (0.03%) epidural abscesses and 1 (0.01%) arachnoiditis. 204 of these patients presented sensory or motor deficits at hospital discharge and needed follow-up. Permanent peripheral nerve injury after neuraxial block had an incidence of 7.7:10,000 (0.08%). The most common side effects after peripheral nerve block were sensory deficits (52%) and 21 patients maintained follow-up due to symptoms persistence after hospital discharge. ConclusionAlthough we found similar incidences of side effects or even lower than those described, major complications after neuraxial block had a higher incidence, particularly epidural abscesses. Despite this, other serious complications, such as spinal hematoma and permanent peripheral nerve injury, are still rare.

Peripheral Nerve Blocks for Postdural Puncture Headache: A New Solution for an Old Problem?

Postdural puncture headache (PDPH) is one of the earliest recognized complications of regional anesthesia after inadvertent dural puncture. Epidural blood patch (EBP) is the "gold standard" for the treatment of PDPH. Several alternatives have been suggested as peripheral nerve blocks. The aim of this systematic review was to find out the potential efficacy and safety of peripheral nerve blocks for the treatment of PDPH. The main databases were systematically searched in September 2020 for studies examining regional anesthesia and PDPH. Nineteen studies were identified, including a total of 221 patients. Sphenopalatine ganglion block, greater occipital nerve block, and lesser occipital nerve block were performed. All participants reported a numeric rating scale (NRS) <4 after peripheral nerve blocks at 1, 24 and 48 h. Only patients with PDPH after diagnostic lumbar puncture reported NRS ≥4 after 48 h. No major adverse events were reported. Approximately, 17% of patients underwent a second or more peripheral nerve blocks. In 30 participants, EBP was required. To our knowledge, this is the first systematic review on the use of peripheral nerve blocks to treat PDPH. Peripheral nerve blocks can be considered as analgesic options in the management of PDPH.

Regional anaesthesia in patients with diabetes.

Diabetes is the most common metabolic condition worldwide and about 20% of surgical patients will have this condition. It is a major risk-factor for worse outcomes after surgery including mortality; infective and non-infective complications; and increased length of stay. However, diabetes is a modifiable risk-factor, and programs to improve medical management have the potential to reduce peri-operative complications and the risk of harm. Regional anaesthesia has well-documented benefits in promoting the restoration of function but there are legitimate concerns that the incidence of complications of regional anaesthesia in patients with diabetes is higher. The aim of this review is to explore in detail the various potential advantages and disadvantages of regional anaesthesia in patients with diabetes. This, in turn, will allow practitioners to undertake more informed shared decision-making and potentially modify their anaesthetic technique for patients with diabetes.

Complications in paediatric regional anaesthesia: a narrative review

Paediatric anaesthesia and paediatric regional anaesthesia are intertwined. Currently, almost all paediatric patients posted for surgery could and should be given a regional block unless and until contraindicated. This is because the scope, techniques, and their benefits have a wide range and complications are rare. The first report that used regional anaesthesia in children was in 1898, and over the last 120 years it has been developed with many scholars’ wisdom, ideas and publications. Paediatric regional anaesthesia (PRA) has many advantages but requires experience and expertise. For a long-time, exclusively landmark-guided techniques were used and gradually the development of new techniques such as the use of neuro-stimulator and ultrasound-guided (USG) blocks developed into PRA. Especially, the application of ultrasonography (US) has revolutionised the practice of PRA. Few limitations of regional anaesthesia can be tackled by the use of US, leading to shorter time to perform the block, reduced time for block onset and use of a smaller volume of local anaesthetic. Life threatening complications of regional anaesthesia are rare and the riskbenefit ratio is favourable. However, a thorough insight into RA complications, no matter how rare they are, is essential for safe practice. This is because they can be life-threatening, and no matter how small the percentage is, when complications occur, for that individual patient statistics is irrelevant.

Updates on neurologic complications in pediatric regional anesthesia.

Regional anesthesia has grown in popularity as a multimodal approach to analgesia. However, some anesthesiologists are fearful of regional blocks in pediatric patients as most require general anesthesia. One of the most alarming complications is neurologic injury. While there are limited case reports regarding the devastating neurologic injuries in pediatric patients, review of large databases has shown a level of safety in pediatric regional anesthesia that is comparable to that in adult patients. This review aimed to provide an update on the relevant literature regarding neurologic complications and the safety of regional blocks in pediatric patients. These large data sets have confirmed that regional anesthesia is a useful and safe modality in pediatric patients.

Complication of regional anaesthesia in addition of midazolam with hyperbaric bupivacaine 0.5% in intrathecal block – A Comparative Study done in tertiary care centre

Complication of regional anaesthesia in addition of midazolam with hyperbaric bupivacaine 0.5% in intrathecal block – A Comparative Study done in tertiary care centre

HEMIDIAPHRAGMATIC PARALYSIS AS A RESULT OF INTERSCALENE BRACHIAL PLEXUS NERVE BLOCK FOR POSTOPERATIVE PAIN

SESSION TITLE: Wednesday Medical Student/Resident Case Report Posters SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: 10/23/2019 09:45 AM - 10:45 AM INTRODUCTION: Hemidiaphragmatic paralysis (HDP) is an uncommon complication of an interscalene brachial plexus block (ISBPB) and normally resolves within the first few days to months. In rare occurrences HDP can be permanent. CASE PRESENTATION: A 71-year-old female presented for a three-month history of worsening shortness of breath and developed fever, productive cough, and myalgias in the preceding days. A chest x-ray showed right-sided lower lobe consolidation. The patient was diagnosed with community-acquired pneumonia and placed on antibiotics. Six-weeks after diagnosis the patient had resolution of the cough, fever, and myalgia, without improvement in her shortness of breath. A CT scan of the chest demonstrated complete resolution of her pneumonia. However, she was noted to have elevation of her right hemidiphragm to the level of the carina. Her only prior imaging was a CT of the abdomen obtained approximately one-year prior that showed a normal diaphragm. As her only recent medical history was a right rotator cuff repair, the operative report was reviewed. The report revealed that she had a right ISBPB for pain control, a procedure that has been associated with HDP (3). A sniff test showed complete paralysis of the right hemidiaphragm. EMG testing confirmed right phrenic nerve palsy and no cervical radiculopathy. The patient has had regular follow up over the past three years with repeat sniff testing continues to show paralysis of the right hemidiaphragm. DISCUSSION: ISBPB is an effective method for controlling pain after shoulder surgery and is regular practice in orthopedic surgery. While most complications of ISBPB are benign, this procedure has been associated with serious complications such as motor weakness, pneumothorax, and HDP (1). While cases of HDP usually resolve within the first 6 months, paralysis can be permanent (2). HDP as a complication of ISBPB occurs due to needle trauma, intraneuronal injection, or local toxicity of the anesthetic (2). Technique of the interscalene block has changed since the institution of routine ultrasound in anesthetic procedures. Changing from landmark-guided to ultrasound-guided technique has resulted in a significant decline in phrenic nerve paralysis (3). Phrenic nerve and resultant diaphragmatic paralysis can lead to difficulty clearing secretions, bronchiatatic changes in the lungs, and an increased risk for infection. The above case illustrates a patient who may have developed pneumonia due to HDP. CONCLUSIONS: HDP is an uncommon but potentially serious complication of ISBPB. Although the paralysis is usually short-lived, it can be permanent with long-term implications for development of subsequent pulmonary disease. The use of intraprocedural ultrasound has significantly reduced the occurrence of HDP. Practitioners performing these nerve blocks should consider using ultrasound to reduce the risk of unintended complications. Reference #1: Bowens, C., & Sripada, R. (2012). Regional Blockade of the Shoulder: Approaches and Outcomes. Anesthesiology Research and Practice, 2012, 1-12. https://doi.org/10.1155/2012/971963 Reference #2: Borgeat, A., Ekatodramis, G., Kalberer, F., & Benz, C. (2001). Acute and Nonacute Complications Associated with Interscalene Block and Shoulder Surgery. Anesthesiology, 95(4), 875-880. https://doi.org/10.1097/00000542-200110000-00015 Reference #3: Borgeat, A., Blumenthal, S., & Hadžić, A. (2007). Mechanisms of Neurologic Complications with Peripheral Nerve Blocks. Complications of Regional Anesthesia, 74-86. https://doi.org/10.1007/978-0-387-68904-3_5 DISCLOSURES: No relevant relationships by Eric Micallef, source=Web Response No relevant relationships by Ellen Mooney, source=Web Response

Regional Nerve Blocks-Best Practice Strategies for Reduction in Complications and Comprehensive Review.

Understanding the etiologies of the complications associated with regional anesthesia and implementing methods to reduce their occurrence provides an opportunity to foster safer practices in the delivery of regional anesthesia. Neurologic injuries following peripheral nerve block (PNB) and neuraxial blocks are rare, with most being transient. However, long-lasting and devastating sequelae can occur with regional anesthesia. Risk factors for neurologic injury following PNB include type of block, injection in the presence of deep sedation or general anesthesia, presence of existing neuropathy, mechanical trauma from the needle, pressure injury, intraneural injection, neuronal ischemia, iatrogenic injury related to surgery, and local anesthetic neurotoxicity. The present investigation discusses regional blocks, complications of regional blocks, risk factors, site-specific limitations, specific complications and how to prevent them from happening, avoiding complications in regional anesthesia, and the future of regional anesthesia.

Complications in Pediatric Regional Anesthesia: An Analysis of More than 100,000 Blocks from the Pediatric Regional Anesthesia Network.

WHAT THIS ARTICLE TELLS US THAT IS NEW: BACKGROUND:: Complications in pediatric regional anesthesia are rare, so a large sample size is necessary to quantify risk. The Pediatric Regional Anesthesia Network contains data on more than 100,000 blocks administered at more than 20 children's hospitals. This study analyzed the risk of major complications associated with regional anesthesia in children. This is a prospective, observational study of routine clinical practice. Data were collected on every regional block placed by an anesthesiologist at participating institutions and were uploaded to a secure database. The data were audited at multiple points for accuracy. There were no permanent neurologic deficits reported (95% CI, 0 to 0.4:10,000). The risk of transient neurologic deficit was 2.4:10,000 (95% CI, 1.6 to 3.6:10,000) and was not different between peripheral and neuraxial blocks. The risk of severe local anesthetic systemic toxicity was 0.76:10,000 (95% CI, 0.3 to 1.6:10,000); the majority of cases occurred in infants. There was one epidural abscess reported (0.76:10,000, 95% CI, 0 to 4.8:10,000). The incidence of cutaneous infections was 0.5% (53:10,000, 95% CI, 43 to 64:10,000). There were no hematomas associated with neuraxial catheters (95% CI, 0 to 3.5:10,000), but one epidural hematoma occurred with a paravertebral catheter. No additional risk was observed with placing blocks under general anesthesia. The most common adverse events were benign catheter-related failures (4%). The data from this study demonstrate a level of safety in pediatric regional anesthesia that is comparable to adult practice and confirms the safety of placing blocks under general anesthesia in children.

Introduction of a mandatory pre-block safety checklist into a regional anaesthesia block room service: a quality improvement project.

Wrong-side block is an uncommon yet potentially preventable complication of regional anaesthesia. One strategy for reducing the incidence of wrong-side block is to introduce an additional check into the pre-block workflow in the form of a block 'time out' or 'stop before you block'. In the aftermath of a wrong-side block incident at our institution, the mandatory use of a pre-block safety checklist was successfully introduced into the workflow of the block room. Compliance with the checklist rose from 31% in the six-month pre-intervention phase to over 90% in the six-month post-intervention phase. This was achieved without any negative effect on block efficacy, theatre efficiency, complication rates or patient satisfaction. The high rate of checklist utilisation was associated with an increased rate of ultrasound video documentation. This suggests that there may be collateral benefit to using a pre-block safety checklist in addition to merely reducing the risk of wrong-side block.

Complications of Regional Anesthesia, 3rd ed

Complications of Regional Anesthesia, 3rd ed

Regional Anesthesia Complications Correlated With Morbid Obesity [34F

INTRODUCTION: Maternal obesity increases anesthesia complication at Cesarean Delivery(CD). We sought to evaluate the contribution of technical factors to anesthesia complications during scheduled CD. METHODS: All patients undergoing scheduled CD under spinal anesthesia at 37-41 weeks from 2015-2017 were included. Exclusion criteria included planned general anesthesia. Primary outcome was total spinal procedure time. Secondary outcomes: number of spinal placement attempts, spinal needle &gt; 3.5 inches, failed placement of spinal with conversion to general anesthesia, high spinal blockade, and additional intravenous analgesics. RESULTS: Of 575 included patients, 131 (23%) had BMI &lt;30 kg/m2 (Group I), 275 (48%) had BMI 30.0-39.9 kg/m2 (Group II), and 169 (29%) had BMI &gt; 40.0 kg/m2 (Group III). Total spinal time increased with BMI (I:5±4 min, II:6±9 min, III:8±7 min, P &lt; .01). More than 1 spinal placement attempt was more frequent among obese patients [I:7/122 (6%), II:27/248 (11%), III:36/157 (23%), P &lt; .001], as was needle length &gt; 3.5 cm [I:2/122 (2%) vs. II:13/238(6%), III:39/158(25%), P = .04]. More obese patients required additional intravenous analgesics [I:12(9%), II: 31(11%), III:20(12%), P = .03] to complete the surgery. Failed placement of spinal with conversion to general (n = 3,2,2, P = 1) and high spinal blockade (n = 0,2,2, P = 1) were both uncommon and similar between groups. CONCLUSION: Although spinal anesthesia placement was more complicated among obese patients, the incidence of serious anesthesia complications remained low. Spinal anesthesia remains an acceptable choice for scheduled CD in obese patients.

Peripheral Regional Anesthesia Without Any Complications - a Dream Comes True?!

Peripheral regional anesthesia procedures, such as femoral nerve block, are relatively safe procedures in clinical anesthesia. Nevertheless, it may lead to typical, usually transient and rarely even persistent complications. This article aims to highlight key aspects of complications in peripheral regional anesthesia and, in particular, strategies to reduce risk. Moreover, beside general complications, which might potentially occur in any peripheral nerve blockade ("bleeding/infection/nerve damage"), accidental co-blockades of other nerval structures are discussed using the example of the brachial plexus. In addition to the presentation of the possible complications, this article discusses improvements in the techniques during the last two decades. Due to the use of ultrasound, some side effects nowadays are supposed to occur less likely. An outlook into the future will inform the reader about improved or more selective blockages.