Complications of regional anesthesia

Perioperative nerve injuries have long been recognized as a complication of regional anesthesia. Although severe or disabling neurologic complications are rare, recent epidemiologic series suggest the frequency of some serious complications is increasing. Risk factors contributing to neurologic deficit after regional anesthesia includes neural ischemia (hypothesized to be related to the use of vasoconstrictors or prolonged hypotension), traumatic injury to the nerves during needle or catheter placement, infection, and choice of local anesthetic solution. In addition, postoperative neurologic injury due to pressure from improper patient positioning or from tightly applied casts or surgical dressings, as well as surgical trauma are often attributed to the regional anesthetic. Patient factors such as body habitus and pre-existing neurologic dysfunction may also contribute. The safe conduct of regional anesthesia involves knowledge of the laboratory studies, large patient series as well as individual case reports of neurologic deficits following regional anesthetic techniques. Prevention of complications, along with early diagnosis and treatment are important in the management of regional anesthetic risks.