Journal: Anesth Analg 104(6):1578-1582, 2007. 26 References
Reprint: Klinik and Poliklinik fuer Anaesthesiologie und Intensivtherapie, Universitaetsklinikum Leipzig, Liebigstrasse 20, D-04103 Leipzig, Germany (M Wiegel, MD)
Faculty Disclosure: Abstracted by J. Joyce, who has nothing to disclose.
Peripheral nerve blocks provide many perioperative benefits, such as reduced opioid requirement, decreased incidence of hemodynamic instability, and less postoperative nausea and vomiting. Moreover, continuous peripheral nerve blocks (CPNBs) significantly improve postoperative pain control. Acceptance of CPNBs may be improved by increasing the availability of systematic data on complications and adverse effects.
In this study, the authors prospectively analyzed complications and adverse effects related to sciatic, femoral, and interscalene brachial plexus CPNBs in consecutive orthopedic patients; 1398 CPNBs in 849 consecutive patients (500 female), mean age 65±13 yr, were analyzed between 2002 and 2004. Of these, 221 patients received interscalene, 628 patients femoral, and 549 patients received sciatic CPNBs. In total, there were 9 cases of local inflammation at the insertion site, and 3 local infections. In one patient undergoing a femoral technique, a retroperitoneal hematoma led to compression injury of the femoral nerve. No other major neurological complications were noted. Vascular puncture occurred in approximately 6% of patients undergoing femoral and sciatic CPNBs. Catheter rupture was noted in one patient.
The results of this study add to the body of evidence that major complications of CPNBs are rare. These data confirm that minor adverse effects are not uncommon after interscalene, femoral, and sciatic CPNBs. Catheter-induced complications need to be considered in addition to needle-induced and local anesthetic-induced complications when studying complications and adverse effects associated with CPNBs. Possible catheter-induced complications include infection and anatomical damage, but also the rare occurrence of catheter shearing.
The data from this study confirm that major needle-induced complications are rare. Accidental vascular puncture was not uncommon during performance of femoral and sciatic CPNBs. Although it does not usually result in significant bleeding, hematoma formation can cause nerve injury due to pressure ischemia. The authors recognized only one local anesthetic-induced complication — methemoglobinemia. Although the incidence of seizures reportedly ranges from 1 to 4 per 1000 of regional anesthesia procedures, neither seizures nor cardiovascular complications were observed.
Major complications of interscalene CPNBs are pneumothorax and impaired pulmonary function due to hemidiaphragmatic paresis. Common minor adverse effects are hoarseness and a Horner syndrome. The incidence of hoarseness and Horner syndrome was less frequent when the local anesthetic was injected through the catheter and thus administered more caudally. This could explain the higher incidence in this study because the local anesthetic was injected first and then the catheter was inserted. |
