Medical Legal Aspects of Regional Anesthesia: Physician Perspective

  • Albert H. Santora

Key Points

  • • A legal relationship exists when a patient voluntarily and with informed or, under special circumstances, implied consent, seeks the care of a physician who accepts the responsibility to render such care.

  • • It is suggested that anesthesiologists familiarize themselves with basic legal tenets and terms relating to liability and malpractice in the event that a claim is brought against them. Familiarity with the legal process before being sued is also recommended.

  • • Many professional guidelines, standards, and statements exist, including those published by the American Society of Anesthesiologists, which address all aspects of anesthesia practice.

  • • Use of other items, such as pre-procedural checklists and time outs, are recommended to help achieve optimum safety when administering regional anesthesia.


Medical malpractice Physician–patient relationship Informed consent Legal terminology: tort law American Society of Anesthesiologists’ Closed Claims Project American Society of Anesthesiologists’ Statements and Guidelines Expert witness Risk management and quality assurance Awareness Checklists in medicine Wrong-site nerve blocks Time out 



The author thanks H. Joseph Byron, Esq. for reviewing this chapter and offering expert editorial advice concerning legal issues.


  1. 1.
    Billington JH. Respectfully quoted: a dictionary of quotations. Mineola: Dover Publications; 2010.Google Scholar
  2. 2.
    O’Brien G, Bartlett J. Bartlett’s familiar quotations. 18th ed. Boston: Little, Brown and Company; 2012.Google Scholar
  3. 3.
    ASA Committee on Professional Liability. Manual on professional liability. Schaumburg: American Society of Anesthesiologists; 2010.Google Scholar
  4. 4.
    ASA Committee on Ethics. Syllabus on ethics 2015. Shaumburg: American Society of Anesthesiologists; 2015.Google Scholar
  5. 5.
    ASA Committee on Ethics. Guidelines for the ethical practice of anesthesiology. Schaumburg: American Society of Anesthesiologists; 2013.Google Scholar
  6. 6.
    ASA Anesthesia Care Team. Statement on regional anesthesia. Schaumburg: American Society of Anesthesiologists; 2012.Google Scholar
  7. 7.
    ASA Committee on Quality Management and Departmental Administration. Statement on standard practice for avoidance of medication errors in neuroaxial anesthesia. Schaumburg: American Society of Anesthesiologists; 2015.Google Scholar
  8. 8.
    ASA Committee on Obstetric Anesthesia. Guidelines for neuraxial anesthesia in obstetrics. Schaumburg: American Society of Anesthesiologists; 2013.Google Scholar
  9. 9.
    ASA Committee on Pain Medicine. Statement on anesthetic care during interventional pain procedures for adults. Schaumburg: American Society of Anesthesiologists; 2010.Google Scholar
  10. 10.
    ASA Committee on Standard and Practice Parameters. Statement on privileging for chronic pain management. Schaumburg: American Society of Anesthesiologists; 2013.Google Scholar
  11. 11.
    Garner BA. Black’s law dictionary. 9th ed. Eagan: West; 2009.Google Scholar
  12. 12.
    Tinker JH, Hesson WW. What to do if sued: an analysis of the allegations of malpractice brought against an anesthesia provider. In: Benumof JL, Saidman LJ, editors. Risk management, anesthesia and perioperative complications. St. Louis: Mosby Year Book; 1992.Google Scholar
  13. 13.
    ASA Committee on Professional Liability. Guidelines for expert witness qualifications and testimony. Schaumburg: American Society of Anesthesiologists; 2013.Google Scholar
  14. 14.
    American Society of Anesthesiologists—Bylaws. Accessed 17 Oct 2007.
  15. 15.
    Cheney FW. The American Society of Anesthesiologists closed claims project: the beginning. Anesthesiology. 2010;113:957–60.CrossRefPubMedGoogle Scholar
  16. 16.
    Posner KL. Data reveal trends in anesthesia malpractice payments. ASA Newslett. 2004;68:7–8, 14.Google Scholar
  17. 17.
    Neal JM, Bernards CM, Hadzic A, Hebl JR, Hogan QH, Horlocker TT, Lee LA, Rathmell JP, Sorenson EJ, Suresh S, Wedel DJ. ASRA practice advisory on neurologic complications in regional anesthesia and pain medicine. Reg Anesth Pain Med. 2008;33:404–15.CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    Benumof JL. Permanent loss of cervical spinal cord function associated with interscalene block performed under general anesthesia. Anesthesiology. 2000;93:1541–4.CrossRefPubMedGoogle Scholar
  19. 19.
    Benumof JL. Comment on “Perioperative interscalene blockade: an overview of its history and current clinical use”. J Clin Anesth. 2003;15:489.CrossRefPubMedGoogle Scholar
  20. 20.
    Bromage PR. Masked mischief. Reg Anesth. 1996;21:62–3.PubMedGoogle Scholar
  21. 21.
    Bromage PR, Benumof JL. Paraplegia following intracord injection during attempted epidural anesthesia under general anesthesia. Reg Anesth Pain Med. 1998;23:104–7.CrossRefPubMedGoogle Scholar
  22. 22.
    Fischer HB. Performing epidural insertion under general anaesthesia. Anaesthesia. 2000;55:288–9.CrossRefPubMedGoogle Scholar
  23. 23.
    Kao MC, Tsai SK, Tsou MY, Lee HK, Guo WY, Hu JS. Paraplegia after delayed detection of inadvertent spinal cord injury during thoracic epidural catheterization in an anesthetized elderly patient. Anesth Analg. 2004;99:580–3, table.Google Scholar
  24. 24.
    Rosenquist RW, Birnbach DJ. Epidural insertion in anesthetized adults: will your patients thank you? Anesth Analg. 2003;96:1545–6.CrossRefPubMedGoogle Scholar
  25. 25.
    Kessler P, Steinfeldt T, Gogarten W, Schwemmer U, Buttner J, Graf BM, Volk T. [Peripheral regional anesthesia in patients under general anesthesia: risk assessment with respect to parasthesia, injection pain and nerve damage]. Anaesthesist. 2013;62:483–8.Google Scholar
  26. 26.
    Devera HV, Furukawa KT, Scavone JA, Matson M, Tumber S. Interscalene blocks in anesthetized pediatric patients. Reg Anesth Pain Med. 2009;34:603–4.CrossRefPubMedGoogle Scholar
  27. 27.
    Giaufre E, Dalens B, Gombert A. Epidemiology and morbidity of regional anesthesia in children: a one-year prospective survey of the French-Language Society of Pediatric Anesthesiologists. Anesth Analg. 1996;83:904–12.CrossRefPubMedGoogle Scholar
  28. 28.
    Polaner DM, Taenzer AH, Walker BJ, Bosenberg A, Krane EJ, Suresh S, Wolf C, Martin LD. Pediatric Regional Anesthesia Network (PRAN): a multi-institutional study of the use and incidence of complications of pediatric regional anesthesia. Anesth Analg. 2012;115:1353–64.CrossRefPubMedGoogle Scholar
  29. 29.
    Taenzer A, Walker BJ, Bosenberg AT, Krane EJ, Martin LD, Polaner DM, Wolf C, Suresh S. Interscalene brachial plexus blocks under general anesthesia in children: is this safe practice?: a report from the Pediatric Regional Anesthesia Network (PRAN). Reg Anesth Pain Med. 2014;39:502–5.CrossRefPubMedGoogle Scholar
  30. 30.
    Taenzer AH, Walker BJ, Bosenberg AT, Martin L, Suresh S, Polaner DM, Wolf C, Krane EJ. Asleep versus awake: does it matter?: pediatric regional block complications by patient state: a report from the Pediatric Regional Anesthesia Network. Reg Anesth Pain Med. 2014;39:279–83.CrossRefPubMedGoogle Scholar
  31. 31.
    Meyer MJ, Krane EJ, Goldschneider KR, Klein NJ. Case report: neurological complications associated with epidural analgesia in children: a report of 4 cases of ambiguous etiologies. Anesth Analg. 2012;115:1365–70.CrossRefPubMedGoogle Scholar
  32. 32.
    Berde C, Greco C. Pediatric regional anesthesia: drawing inferences on safety from prospective registries and case reports. Anesth Analg. 2012;115:1259–62.CrossRefPubMedGoogle Scholar
  33. 33.
    Kent CD, Mashour GA, Metzger NA, Posner KL, Domino KB. Psychological impact of unexpected explicit recall of events occurring during surgery performed under sedation, regional anaesthesia, and general anaesthesia: data from the Anesthesia Awareness Registry. Br J Anaesth. 2013;110:381–7.CrossRefPubMedGoogle Scholar
  34. 34.
    Mihai R, Scott S, Cook TM. Litigation related to inadequate anaesthesia: an analysis of claims against the NHS in England 1995–2007. Anaesthesia. 2009;64:829–35.CrossRefPubMedGoogle Scholar
  35. 35.
    Wedel DJ. Can regional anesthesia worsen outcome? Medicolegal risk. Reg Anesth. 1996;21:71–4.PubMedGoogle Scholar
  36. 36.
    Gillespie BM, Chaboyer W, Thalib L, John M, Fairweather N, Slater K. Effect of using a safety checklist on patient complications after surgery: a systematic review and meta-analysis. Anesthesiology. 2014;120:1380–9.CrossRefPubMedGoogle Scholar
  37. 37.
    Myers JW, Kwock J. The labor epidural time out checklist. APSF newsletter. 2015;2015:62–3.Google Scholar
  38. 38.
    Treadwell JR, Lucas S: Preoperative Checklists and Anesthesia Checklists, Evidence Reports/Technology Assessments, No. 211. Making Health Care Safer II: An Updated Critical Analysis of the Evidence for Patient Safety Practices. Rockville: Agency for Healthcare Research and Quality (US); 2013.Google Scholar
  39. 39.
    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
  40. 40.
    Mulroy MF, Weller RS, Liguori GA. A checklist for performing regional nerve blocks. Reg Anesth Pain Med. 2014;39:195–9.CrossRefPubMedGoogle Scholar
  41. 41.
    Mulroy MF. A checklist for performing regional nerve blocks: erratum. Reg Anesth Pain Med. 2014;39:357.CrossRefGoogle Scholar

Copyright information

© Springer International Publishing AG 2017

Authors and Affiliations

  1. 1.St. Mary’s HospitalAthensUSA

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