Complications and Mitigation in Regional Anesthesia

Summary: Complications in regional anesthesia are multifactorial and very complex. There are multiple surgical, anesthesiologic and patient related factors for nerve injury. The incidence of nerve damage in regional anesthesia varies significantly in a very low range. In most cases there are several combined factors that lead to a nerve damage. Histologically you will find damaged myelin layers and axonal degeneration. Fortunately this neuropraxia has the best outcome and perioperative neurological deficits will disappear completely in more than 95% of the cases. There are a lot of preprocedural precautions to provide good blocks and to avoid nerve injuries. Beginning with the medical explanation, consent of the patient, documentation of all the patients related factors, continuing in the holding area with monitoring, if necessary slight sedations, up to positioning of the patient and ergonomics of the anesthetist.  Then choosing the optimal technique with the correct needle under sterile conditions with the minimal dosage of local anesthetics required will avoid side effects or even complications like LATS, hematoma, infections and last but not least nerve injuries. But the key point to mitigate nerve damages are in fact the skills of well trained anesthetists preferably with the support of high quality US machines with high resolution to detect needle and targeted nerves very precisely. In case of poor visibility the provider can use stimulation technique and even go for triple guidance technique using pressure monitoring devices aswell. Keeping all these facts and procedures in mind will provide perfect blocks without any harm to our patients