Barrington Michael J, Uda Yoshiaki, Pattullo Simon J, Sites Brian D
aDepartment of Anaesthesia and Acute Pain Medicine, St. Vincent's Hospital, Melbourne bFaculty of Medicine, Melbourne Medical School, Dentistry and Health Sciences, University of Melbourne, Parkville, Victoria cDepartment of Anaesthesia, Gold Coast University Hospital, Southport, Queensland, Australia dDepartment of Anesthesiology and Pain Management, Dartmouth-Hitchcock Medical Center, Lebanon eGeisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA.
Curr Opin Anaesthesiol. 2015 Dec;28(6):670-84. doi: 10.1097/ACO.0000000000000258.
Wrong-site regional anesthetic procedures are considered never events. The purpose of this review is to describe the phenomenon of wrong-site regional anesthetic blocks and identify preventive strategies.
The incidence of wrong-site block may be as frequent as 7.5 per 10,000 procedures. Factors contributing to wrong-site block include physician distraction, patient position change, scheduling changes, inadequate documentation, poor communication, lack of surgical consent, site marking not visible, inadequate supervision, reduced situational awareness, fatigue, cognitive overload, perceived time pressure, delay from World Health sign-in to block performance and omission of block time-out or block time-out occurring before final patient positioning. The American Society of Regional Anesthesia and Pain Medicine have created a 9-point checklist for regional anesthesia procedures.
Preoperative site verification and surgical site marking are mandatory. A time-out should occur immediately before any invasive procedure. Confirming the correct patient and block site with a time-out should occur immediately before all regional anesthetic procedures. If more than one block is performed on one patient, it is recommended that time-out be repeated each time the patient position is changed or separated in time or performed by a different team. The anesthetic team should uniformly implement robust guidelines and checklists to reduce the occurrence of wrong-site regional anesthetic procedures.
错误部位的区域麻醉操作被视为严重医疗差错。本综述的目的是描述错误部位区域麻醉阻滞的现象并确定预防策略。
错误部位阻滞的发生率可能高达每10000例操作中出现7.5例。导致错误部位阻滞的因素包括医生分心、患者体位改变、手术安排变更、记录不充分、沟通不畅、缺乏手术同意书、手术部位标记不可见、监督不足、情境意识降低、疲劳、认知负荷过重、感知到的时间压力、从世界卫生组织签到至实施阻滞的延迟以及遗漏阻滞暂停或在患者最终体位确定前进行阻滞暂停。美国区域麻醉与疼痛医学学会制定了一份区域麻醉操作的9点检查表。
术前部位核实和手术部位标记是必需的。在任何侵入性操作前都应立即进行暂停核对。在所有区域麻醉操作前，都应通过暂停核对确认患者和阻滞部位正确。如果对一名患者进行不止一次阻滞，建议每当患者体位改变、时间间隔或由不同团队进行操作时重复进行暂停核对。麻醉团队应统一执行严格的指南和检查表，以减少错误部位区域麻醉操作的发生。
