Australia: Results of a Multicenter Registry of Regional Anesthesia

  • Michael J. Barrington

Key Points

  • The primary goal of this registry was to determine the quality and safety of our current routine practice of peripheral nerve blockade.

  • This chapter presents a summary of results from the Australasian Regional Anaesthesia Collaboration and the Australian and New Zealand Registry of Regional Anaesthesia.

  • Results of the Australasian Regional Anesthesia Collaboration showed an incidence of 0.4/1000 peripheral nerve blocks for neurologic injury related to the block (out of 8189 blocks). Incidence of local anesthetic toxicity was 0.98/1000.

  • Results of the Australian and New Zealand Registry of Regional Anaesthesia revealed incidences of peripheral nerve block-related late and long-term neurological deficits were 0.6 and 0.3 per 1000 blocks, respectively. Incidence of local anesthetic toxicity was 0.87/1000.

  • Patients with postoperative neurologic features were more likely to have a cause unrelated to peripheral nerve blockade.

  • The results presented from this registry demonstrate that the incidence of serious permanent neurologic complications attributable to peripheral nerve block is rare.

  • The risk of local anesthetic systemic toxicity was reduced with ultrasound guidance and increased body weight. Local anesthetic dosage and site of injection were predictors of local anesthetic systemic toxicity.

  • Incidence of post-block respiratory impairment was relatively higher (3.4/1000). Other complications, such as wrong-site blocks and pneumothorax, while rare, were nevertheless captured by the registry.


Local anesthetic dosage Adverse effects Nerve blocks Registries Ultrasonography Peripheral nervous system 



Australasian Regional Anaesthesia Collaboration


The Australian and New Zealand Registry of Regional Anaesthesia


Local anesthetic systemic toxicity


Peripheral nerve blockade


Postoperative Nerve Injury


  1. 1.
    Cheney FW, Domino KB, Caplan RA, Posner KL. Nerve injury associated with anesthesia: a closed claims analysis. Anesthesiology. 1999;90:1062–9.CrossRefPubMedGoogle Scholar
  2. 2.
    Welch MB, Brummett CM, Welch TD, Tremper KK, Shanks AM, Guglani P, Mashour GA. Perioperative peripheral nerve injuries: a retrospective study of 380,680 cases during a 10-year period at a single institution. Anesthesiology. 2009;111:490–7.CrossRefPubMedGoogle Scholar
  3. 3.
    Holdcroft A, Gibberd FB, Hargrove RL, Hawkins DF, Dellaportas CI. Neurological complications associated with pregnancy. Br J Anaesth. 1995;75:522–6.CrossRefPubMedGoogle Scholar
  4. 4.
    de Bruijn IL, Geertzen JH, Dijkstra PU. Functional outcome after peroneal nerve injury. Int J Rehabil Res. 2007;30:333–7.CrossRefPubMedGoogle Scholar
  5. 5.
    Warner MA, Warner ME, JT M. Ulnar neuropathy. Incidence, outcome, and risk factors in sedated or anesthetized patients. Anesthesiology. 1994;81:1332–40.CrossRefPubMedGoogle Scholar
  6. 6.
    Barrington MJ, Watts SA, Gledhill SR, Thomas RD, Said SA, Snyder GL, Tay VS, Jamrozik K. Preliminary results of the Australasian Regional Anaesthesia Collaboration: a prospective audit of more than 7000 peripheral nerve and plexus blocks for neurologic and other complications. Reg Anesth Pain Med. 2009;34:534–41.CrossRefPubMedGoogle Scholar
  7. 7.
    Liguori GA. Complications of regional anesthesia: nerve injury and peripheral neural blockade. J Neurosurg Anesthesiol. 2004;16:84–6.CrossRefPubMedGoogle Scholar
  8. 8.
    Borgeat A, Ekatodramis G, Kalberer F, Benz C. Acute and nonacute complications associated with interscalene block and shoulder surgery: a prospective study. Anesthesiology. 2001;95:875–80.CrossRefPubMedGoogle Scholar
  9. 9.
    Candido KD, Sukhani R, Doty R Jr, Nader A, Kendall MC, Yaghmour E, Kataria TC, McCarthy R. Neurologic sequelae after interscalene brachial plexus block for shoulder/upper arm surgery: the association of patient, anesthetic, and surgical factors to the incidence and clinical course. Anesth Analg. 2005;100:1489–95, table.Google Scholar
  10. 10.
    Brull R, McCartney CJ, Chan VW, El-Beheiry H. Neurological complications after regional anesthesia: contemporary estimates of risk. Anesth Analg. 2007;104:965–74.CrossRefPubMedGoogle Scholar
  11. 11.
    Barrington MJ. The quality and safety of peripheral regional anesthesia. The University of Melbourne; 2012Google Scholar
  12. 12.
    Di GG, Neal JM, Rosenquist RW, Weinberg GL. Clinical presentation of local anesthetic systemic toxicity: a review of published cases, 1979 to 2009. Reg Anesth Pain Med. 2010;35:181–7.CrossRefGoogle Scholar
  13. 13.
    Abrahams MS, Aziz MF, Fu RF, Horn JL. Ultrasound guidance compared with electrical neurostimulation for peripheral nerve block: a systematic review and meta-analysis of randomized controlled trials. Br J Anaesth. 2009;102:408–17.CrossRefPubMedGoogle Scholar
  14. 14.
    Zetlaoui PJ, Labbe JP, Benhamou D. Ultrasound guidance for axillary plexus block does not prevent intravascular injection. Anesthesiology. 2008;108:761.CrossRefPubMedGoogle Scholar
  15. 15.
    Barrington MJ, Kluger R. Ultrasound guidance reduces the risk of local anesthetic systemic toxicity following peripheral nerve blockade. Reg Anesth Pain Med. 2013;38:289–99.CrossRefPubMedGoogle Scholar
  16. 16.
    Drasner K. Local anesthetic systemic toxicity: a historical perspective. Reg Anesth Pain Med. 2010;35:162–6.CrossRefPubMedGoogle Scholar
  17. 17.
    Abell DJ, Barrington MJ. Pneumothorax after ultrasound-guided supraclavicular block: presenting features, risk, and related training. Reg Anesth Pain Med. 2014;39:164–7.CrossRefPubMedGoogle Scholar
  18. 18.
    Renes SH, Rettig HC, Gielen MJ, Wilder-Smith OH, van Geffen GJ. Ultrasound-guided low-dose interscalene brachial plexus block reduces the incidence of hemidiaphragmatic paresis. Reg Anesth Pain Med. 2009;34:498–502.CrossRefPubMedGoogle Scholar
  19. 19.
    Renes SH, Spoormans HH, Gielen MJ, Rettig HC, van Geffen GJ. Hemidiaphragmatic paresis can be avoided in ultrasound-guided supraclavicular brachial plexus block. Reg Anesth Pain Med. 2009;34:595–9.CrossRefPubMedGoogle Scholar
  20. 20.
    Sites BD, Barrington MJ, Davis M. Using an international clinical registry of regional anesthesia to identify targets for quality improvement. Reg Anesth Pain Med. 2014;39:487–95.CrossRefPubMedPubMedCentralGoogle Scholar
  21. 21.
    Cohen SP, Hayek SM, Datta S, Bajwa ZH, Larkin TM, Griffith S, Hobelmann G, Christo PJ, White R. Incidence and root cause analysis of wrong-site pain management procedures: a multicenter study. Anesthesiology. 2010;112:711–8.CrossRefPubMedGoogle Scholar
  22. 22.
    Rupp SM. Unintentional wrong-sided peripheral nerve block. Reg Anesth Pain Med. 2008;33:95–7.CrossRefPubMedGoogle Scholar
  23. 23.
    Weiser TG, Haynes AB, Dziekan G, Berry WR, Lipsitz SR, Gawande AA. Effect of a 19-item surgical safety checklist during urgent operations in a global patient population. Ann Surg. 2010;251:976–80.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG 2017

Authors and Affiliations

  1. 1.Department of Anaesthesia and Acute Pain MedicineSt. Vincent’s Hospital, MelbourneMelbourneAustralia
  2. 2.Faculty of Medicine, Dentistry and Health SciencesMelbourne Medical School, University of MelbourneParkvilleAustralia

Personalised recommendations