Department of Anaesthesia, St. Vincent's Hospital, Melbourne, Australia.
Curr Opin Anaesthesiol. 2011 Oct;24(5):554-60. doi: 10.1097/ACO.0b013e32834ae1f7.
Regional anesthesia is evolving rapidly and increasing in popularity as evidenced by the large number of publications on the topic. In this healthcare environment, continual assessment of the safety and efficacy of clinical practice is critical. Neurologic complications of regional anesthesia can result in disability and are feared by patients and clinicians. Ultrasound guidance is unique as a nerve localizing technique in terms of being able to image needle-nerve proximity and potentially prevent direct trauma to nerves. This article reviews the recent literature relevant to neurologic complications of regional anesthesia.
The incidence of intraneural injection during regional anesthesia is higher than previously appreciated. Defining intraneural injection and its significance are the subject of current debate. Clinical studies with small sample sizes suggest that intraneural injection may not necessarily be responsible for nerve injury. Inflammatory mechanisms may contribute to perioperative nerve injury. Ultrasound guidance has not been proven to reduce the incidence of nerve injury due to peripheral nerve blockade (PNB). Increased utilization of PNB is not associated with an increase in perioperative nerve injury.
The pathogenesis of perioperative nerve injury is complex with multiple potential etiologies and mechanisms. The role of intraneural injections as a modifiable risk factor for neurologic complications due to regional anesthesia remains topical. Relevant publications include studies on the morphology of peripheral nerves and risk of perioperative nerve injury in the context of both neuraxial anesthesia and PNB.
区域麻醉技术发展迅速，越来越受到欢迎，这一点从大量相关文献中可见一斑。在这种医疗环境下，持续评估临床实践的安全性和有效性至关重要。区域麻醉的神经并发症可导致残疾，令患者和临床医生感到恐惧。超声引导在定位神经方面具有独特的优势，能够实时显示针与神经的位置关系，从而可能防止直接损伤神经。本文就区域麻醉神经并发症的相关最新文献进行综述。
在区域麻醉过程中，神经内注射的发生率高于之前的认识。目前，神经内注射的定义及其意义是讨论的焦点。一些样本量较小的临床研究表明，神经内注射不一定会导致神经损伤。炎症机制可能导致围手术期神经损伤。超声引导并不能降低外周神经阻滞（PNB）导致的神经损伤发生率。PNB 使用率的增加与围手术期神经损伤的增加无关。
围手术期神经损伤的发病机制复杂，可能涉及多种潜在病因和机制。神经内注射作为区域麻醉神经并发症的可改变危险因素的作用仍然是研究的热点。相关文献包括关于外周神经形态学和神经轴麻醉及 PNB 背景下围手术期神经损伤风险的研究。
