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Complications associated with eye blocks and peripheral nerve blocks: an american society of anesthesiologists closed claims analysis.

Abstract：

BACKGROUND AND OBJECTIVES:Concern for block-related injury and liability has dissuaded many anesthesiologists from using regional anesthesia for eye and extremity surgery, despite many studies demonstrating the benefits of regional over general anesthesia. To determine injury patterns and liability associated with eye and peripheral nerve blocks, we re-examined the American Society of Anesthesiologists Closed Claims Database as part of the American Society of Regional Anesthesia and Pain Medicine's Practice Advisory on Neurologic Complications of Regional Anesthesia and Pain Medicine. METHODS:Claims with eye or peripheral nerve blocks performed perioperatively from 1980 through 2000 were analyzed. The liability profile of anesthesiologists who provided both the eye block and sedation for eye surgery was compared with the profile of anesthesiologists who provided sedation only. The injury patterns associated with peripheral nerve blocks and payment factors were analyzed. RESULTS:Anesthesiologists who provided both the eye block and sedation for eye surgery (n = 59) had more injuries associated with block placement (P < .001), a higher proportion of claims with permanent injury (P < .05), and a higher proportion of claims with plaintiff payment (P < .05), compared with anesthesiologists who provided sedation only (n = 38). Peripheral nerve blocks (n = 159) were primarily associated with temporary injuries (56%). Local anesthetic toxicity was associated with 7 of 19 claims with death or brain damage. CONCLUSIONS:Performance of eye blocks by anesthesiologists significantly alters their liability profile, primarily related to permanent eye damage from block needle trauma. Though most peripheral nerve block claims are associated with temporary injuries, local anesthetic toxicity is a major cause of death or brain damage in these claims.

journal_name

Reg Anesth Pain Med

journal_title

Regional anesthesia and pain medicine

authors

Lee LA,Posner KL,Cheney FW,Caplan RA,Domino KB

doi

10.1016/j.rapm.2008.01.016

subject

Has Abstract

pub_date

2008-09-01 00:00:00

pages

416-22

issue

eissn

1098-7339

issn

1532-8651

pii

S1098-7339(08)00142-9

journal_volume

pub_type

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Complications associated with eye blocks and peripheral nerve blocks: an american society of anesthesiologists closed claims analysis.