United States: Complications Associated with Regional Anesthesia (An American Society of Anesthesiologists’ Closed Claims Analysis)

  • Christopher Kent
  • Karen L. Posner
  • Lorri A. Lee
  • Karen B. Domino
Chapter

Key Points

  • The American Society of Anesthesiology Closed Claims Project is designed to collect information about and analyze adverse events related to anesthesia. Over 10,500 claims in the database represent events that occurred in 1970–2013.

  • From 2000 to 2013, 445 claims were made relating to regional anesthesia, with obstetric cases comprising about 1/3 of the total. The majority (71 %) of claims were related to neuraxial anesthesia.

  • More cardiovascular and respiratory complications as well as permanent injury or death were reported among neuraxial block claims. Peripheral nerve block claims were more commonly associated with temporary neurologic impairments and local anesthetic systemic toxicity compared to neuraxial block cases.

  • Neurologic injury, including direct needle trauma, was reported for both peripheral and central neuraxial blocks. Several claims related to peripheral nerve blocks were due to wrong-side blocks or administration of the block under general anesthesia.

  • Standards for documentation of regional anesthesia procedures differ among institutions. Poor documentation may put the anesthesiologist at risk of lacking evidence that a procedure was performed according to practice standards or that patient consent was obtained properly.

Keywords

High spinal anesthetic Local anesthetic systemic toxicity Neuraxial hematoma Malpractice Peripheral nerve injury 

Abbreviations

ASA

American Society of Anesthesiologists

ASRA

American Society of Regional Anesthesiologists

CPR

Cardio-pulmonary resuscitation

GA

General anesthesia

ISB

Interscalene block

LAST

Local anesthetic systemic toxicity

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Copyright information

© Springer International Publishing AG 2017

Authors and Affiliations

  • Christopher Kent
    • 1
  • Karen L. Posner
    • 1
  • Lorri A. Lee
    • 2
  • Karen B. Domino
    • 1
  1. 1.Department of Anesthesiology and Pain MedicineUniversity of WashingtonSeattleUSA
  2. 2.Department of AnesthesiologyVanderbilt UniversityNashvilleUSA

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