Sonawane Kartik, Dixit Hrudini, Thota Navya, Mistry Tuhin, Balavenkatasubramanian Jagannathan
Anesthesiology, Ganga Medical Centre and Hospitals, Coimbatore, IND.
Anesthesiology, Sir H. N. Reliance Foundation Hospital and Research Centre, Mumbai, IND.
Cureus. 2023 Aug 8;15(8):e43143. doi: 10.7759/cureus.43143. eCollection 2023 Aug.
Selander emphatically said, "," and those words still echo, conveying a loud and clear message that, however rare, peripheral nerve injury (PNI) remains a perturbing possibility that cannot be ignored. The unprecedented nerve injuries associated with peripheral nerve blocks (PNBs) can be most tormenting for the unfortunate patient and a nightmare for the anesthetist. Possible justifications for the seemingly infrequent occurrences of PNB-related PNIs include a lack of documentation/reporting, improper aftercare, or associated legal implications. Although they make up only a small portion of medicolegal claims, they are sometimes difficult to defend. The most common allegations are attributed to insufficient informed consent; preventable damage to a nerve(s); delay in diagnosis, referral, or treatment; misdiagnosis, and inappropriate treatment and follow-up care. Also, sufficient prospective studies or randomized trials have not been conducted, as exploring such nerve injuries (PNB-related) in living patients or volunteers may be impractical or unethical. Understanding the pathophysiology of various types of nerve injury is vital to dealing with them further. Processes like degeneration, regeneration, remyelination, and reinnervation can influence the findings of electrophysiological studies. Events occurring in such a process and their impact during the assessment determine the prognosis and the need for further interventions. This educational review describes various types of PNB-related nerve injuries and their associated pathophysiology.
“……”，这些话至今仍在回响，传达出一个清晰明确的信息，即无论多么罕见，周围神经损伤（PNI）仍然是一个不容忽视的令人不安的可能性。与周围神经阻滞（PNB）相关的前所未有的神经损伤，对不幸的患者来说可能是极其痛苦的，对麻醉师来说则是一场噩梦。PNB相关的PNI看似不常发生，其可能的原因包括缺乏记录/报告、术后护理不当或相关的法律问题。尽管它们在医疗法律索赔中只占一小部分，但有时却难以辩护。最常见的指控归因于知情同意不足；对神经的可预防损伤；诊断、转诊或治疗延迟；误诊以及不适当的治疗和后续护理。此外，尚未进行足够的前瞻性研究或随机试验，因为在活体患者或志愿者中探索此类（PNB相关的）神经损伤可能不切实际或不符合伦理。了解各种类型神经损伤的病理生理学对于进一步处理它们至关重要。诸如变性、再生、髓鞘再生和神经再支配等过程会影响电生理研究的结果。在这个过程中发生的事件及其在评估期间的影响决定了预后以及进一步干预的必要性。这篇教育综述描述了各种类型的PNB相关神经损伤及其相关的病理生理学。
