Department of Anaesthesia, St Vincent's Hospital, Melbourne, Victoria, Australia.
Reg Anesth Pain Med. 2009 Nov-Dec;34(6):534-41. doi: 10.1097/aap.0b013e3181ae72e8.
Peripheral nerve blockade is associated with excellent patient outcomes after surgery; however, neurologic and other complications can be devastating for the patient. This article reports the development and preliminary results of a multicenter audit describing the quality and safety of peripheral nerve blockade.
From January 2006 to May 2008, patients who received peripheral nerve blockade had data relating to efficacy and complications entered into databases. All patients who received nerve blocks performed by all anesthetists during each hospital's contributing period were included. Patients were followed up by phone to detect potential neurologic complications. The timing of follow-up was either at 7 to 10 days or 6 weeks postoperatively, depending on practice location and time period. Late neurologic deficits were defined as a new onset of sensory and/or motor deficit consistent with a nerve/plexus distribution without other identifiable cause, and one of the following: electrophysiologic evidence of nerve damage, new neurologic signs, new onset of neuropathic pain in a nerve distribution area, paresthesia in relevant nerve/plexus distribution area.
A total of 6950 patients received 8189 peripheral nerve or plexus blocks. Of the 6950 patients, 6069 patients were successfully followed up. In these 6069 patients, there were a total of 7156 blocks forming the denominator for late neurologic complications. Thirty patients (0.5%) had clinical features requiring referral for neurologic assessment. Three of the 30 patients had a block-related nerve injury, giving an incidence of 0.4 per 1000 blocks (95% confidence interval, 0.08-1.1:1000). The incidence of systemic local anesthetic toxicity was 0.98 per 1000 blocks (95% confidence interval, 0.42-1.9:1000).
These results indicate that the incidence of serious complications after peripheral nerve blockade is uncommon and that the origin of neurologic symptoms/signs in the postoperative period is most likely to be unrelated to nerve blockade.
周围神经阻滞与术后患者良好的转归相关，但神经损伤等并发症可能对患者造成毁灭性影响。本文报告了一项多中心审计的结果，该审计描述了周围神经阻滞的质量和安全性。
2006 年 1 月至 2008 年 5 月，接受周围神经阻滞的患者将与疗效和并发症相关的数据输入数据库。纳入每个医院参与研究期间所有接受所有麻醉医生行神经阻滞的患者。通过电话对患者进行随访，以发现潜在的神经并发症。随访时间取决于就诊地点和时间段，为术后 7 至 10 天或 6 周。迟发性神经功能缺损定义为新发的与神经/神经丛分布一致的感觉和/或运动功能障碍，且无其他可识别病因，并伴有以下之一：神经损伤的电生理证据、新的神经体征、神经分布区域出现新发的神经性疼痛、相关神经/神经丛分布区域出现感觉异常。
共 6950 例患者接受了 8189 例周围神经或神经丛阻滞。在 6950 例患者中，有 6069 例患者成功随访。在这 6069 例患者中，共有 7156 例阻滞形成迟发性神经并发症的分母。30 例（0.5%）患者出现需要神经评估的临床特征。30 例患者中有 3 例存在与阻滞相关的神经损伤，每 1000 例阻滞中发生率为 0.4 例（95%置信区间，0.08-1.1：1000）。全身局部麻醉药毒性的发生率为每 1000 例阻滞 0.98 例（95%置信区间，0.42-1.9：1000）。
这些结果表明，周围神经阻滞后严重并发症的发生率并不常见，术后出现神经症状/体征的原因很可能与神经阻滞无关。
