Evaluation of Neurologic Injury Following Regional Anesthesia

  • Quinn Hogan
  • Keith McCollister
  • Matthew Harmelink
  • Laura Kohl
  • Michael Collins

Key Points

  • Neurologic injury associated with regional blockade is rare but does occur. Upon suspicion or discovery of a neurologic injury following a nerve block, factors including preexisting conditions, surgical or anesthetic events, and development/course of the injury should be investigated.

  • Physical examination of neurologic, cognitive, motor, sensory, and reflex function, as well as electrodiagnostic studies, can yield clues as to the source and site of nerve injury following regional anesthesia.

  • Examination of nerve conduction can help evaluate the degree of the injury but can be limited by factors including accessibility and size of the nerve, technical difficulties of electrode placement and response measurement, nature of the injury, and presence of preexisting neuronal damage.

  • Electromyography (EMG) can help determine the location and type of neuronal injury, be it neuropraxia, axonotmesis, or neurotmesis, and prognosis for nerve regeneration or reinnervation. The value of EMG findings is dependent on the skill of the examiner.

  • Imaging technologies, including conventional radiography, computed tomography, magnetic resonance imaging, magnetic resonance neurography, angiography, and ultrasonography, can be used to identify and evaluate neurologic injury.


Neurologic injury Electrodiagnostic studies Nerve conduction Electromyography Neuropraxia Axonotmesis Neurotmesis Reinnervation 



We thank Dr. Paul Barkhaus M.D. for his valuable input in writing this chapter.


  1. 1.
    Bernards C, Hadzic A, Suresh S, Neal J. Regional anesthesia in anesththeized or heavily sedated patients. Reg Anesth Pain Med. 2008;33:449–60.CrossRefPubMedGoogle Scholar
  2. 2.
    Yeun EC, Layzer RB, Weitz SR, Olney RK. Neurologic complications of lumbar epidural anesthesia and analgesia. Neurology. 1995;45:1795–801.CrossRefGoogle Scholar
  3. 3.
    Papilion JD, Neff RS, Shall LM. Compression neuropathy of the radial nerve as a complication of elbow arthroscopy: a case report and review of the literature. Arthroscopy. 1998;4:284–6.CrossRefGoogle Scholar
  4. 4.
    Winfree CJ, Kline DG. Intraoperative positioning nerve injuries. Surg Neurol. 2005;63:5–18.CrossRefPubMedGoogle Scholar
  5. 5.
    Graham JG, Pye IF, McQueen IN. Brachial plexus injury after median sternotomy. J Neurol Neurosurg Psychiatry. 1981;44:621–5.CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Warner MA, Martin JT, Schroeder DR, Offord KP, Chute CG. Lower-extremity motor neuropathy associated with surgery performed on patients in a lithotomy position. Anesthesiology. 1994;81(1):6–12.CrossRefPubMedGoogle Scholar
  7. 7.
    McKinney A, et al. Posterior reversible encephalopathy syndrome: incidence of atypical regions of involvement and imaging findings. AJR Am J Roentgenol. 2007;189:904–12.CrossRefPubMedGoogle Scholar
  8. 8.
    Gravereaux E, et al. Risk of spinal cord ischemia after endograft repair of thoracic aortic aneurysms. J Vasc Surg. 2001;34:997–1003.CrossRefPubMedGoogle Scholar
  9. 9.
    Hurley JP, Wood AE. Isolated man-in-the barrel syndrome following cardiac surgery. Thorac Cardiovasc Surg. 1993;41:252–4.CrossRefPubMedGoogle Scholar
  10. 10.
    Moore DC, Hain RF, Ward A, Bridenbaugh LD. Importance of the perineural spaces in nerve blocking. JAMA. 1954;156:1050–3.CrossRefGoogle Scholar
  11. 11.
    Lewis E, et al. Web-based software to assist in the localization of neuroanatomical lesions. Can J Neurol Sci. 2011;38:251–5.CrossRefPubMedGoogle Scholar
  12. 12.
    O’Brien M. Aids to the examination of the peripheral nervous system. 5th ed: Saunders; 2010.Google Scholar
  13. 13.
    Gilandi N, Horak F, Hausdorff J. Classification of gait disturbances: distinguishing between continuous and episodic changes. Mov Disord. 2013;28:1469–73.CrossRefGoogle Scholar
  14. 14.
    Freeman R, Chapleau MW. Testing the autonomic nervous system. Handb Clin Neurol. 2013;115:115–36.CrossRefPubMedGoogle Scholar
  15. 15.
    Chaudhry V, Comblath DR. Wallerian degeneration in human nerves: serial electrophysiologic studies. Muscle Nerve. 1992;15:687–93.CrossRefPubMedGoogle Scholar
  16. 16.
    Buchthal F, Franuesco E, Rosenfalck P. Motor unit territory in different human muscles. Acta Physiol Scand. 1959;45:72–87.CrossRefPubMedGoogle Scholar
  17. 17.
    Burke RE. Motor units in mammalian muscle. Sumner AJ, ed. The physiology of peripheral nerve disease. Philadelphia, PA: WB Saunders Co; 1980. 133-194.Google Scholar
  18. 18.
    Dumitru D, Amato A, Zwarts M. Electrodiagnostic medicine, 2nd edition. 2001Google Scholar
  19. 19.
    Seddon H. Three types of nerve injury. Brain. 1943;66:237–88.CrossRefGoogle Scholar
  20. 20.
    Chhabra A. Peripheral MR neurography: approach to interpretation. Neuroimaging Clin N Am. 2014;24(1):79–89.CrossRefPubMedGoogle Scholar
  21. 21.
    Baltodano PA, Tong AJ, Chhabra A, Rosson GD. The role of magnetic resonance neurography in the postoperative management of peripheral nerve injuries. Neuroimaging Clin N Am. 2014;24:235–44.CrossRefPubMedGoogle Scholar
  22. 22.
    Abram SE, Yi J, Fuchs A, Hogan QH. Permeability of injured and intact peripheral nerves and dorsal root ganglia. Anesthesiology. 2006;105:146–53.CrossRefPubMedGoogle Scholar
  23. 23.
    Reimer P, Landwehr P. Non-invasive vascular imaging of peripheral vessels. Eur Radiol. 1998;8:858–72.CrossRefPubMedGoogle Scholar
  24. 24.
    Prokop M. Multislice CT angiography. Eur J Radiol. 2000;36:86–96.CrossRefPubMedGoogle Scholar
  25. 25.
    Eddy DM, Clanton CH. The art of diagnosis: solving the clinicopathological exercise. N Engl J Med. 1982;306:1263–8.CrossRefPubMedGoogle Scholar
  26. 26.
    Black WC, Welch HG. Advances in diagnostic imaging and overestimation of disease prevalence and the benefits of therapy. N Engl J Med. 1993;328:1237–43.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG 2017

Authors and Affiliations

  • Quinn Hogan
    • 1
  • Keith McCollister
    • 2
    • 3
  • Matthew Harmelink
    • 4
  • Laura Kohl
    • 2
    • 5
  • Michael Collins
    • 6
  1. 1.Department of AnesthesiologyMedical College of WisconsinMilwaukeeUSA
  2. 2.Department of RadiologyMedical College of WisconsinMilwaukeeUSA
  3. 3.X-Ray Consultants, Inc.South BendUSA
  4. 4.Division of Pediatric Neurology, Department of NeurologyMedical College of WisconsinMilwaukeeUSA
  5. 5.Madison Radiologists SCMadisonUSA
  6. 6.Department of NeurologyMedical College of WisconsinMilwaukeeUSA

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