Emergency Medicine, University of Michigan Health-West, Wyoming, Michigan, USA.
Department of Anaesthesia, Belfast Health and Social Care Trust, Belfast, Northern Ireland, UK.
Reg Anesth Pain Med. 2024 Feb 5;49(2):122-132. doi: 10.1136/rapm-2023-104855.
Peripheral nerve injury or post-block neurological dysfunction (PBND) are uncommon but a recognized complications of peripheral nerve blocks (PNB). A broad range of its incidence is noted in the literature and hence a critical appraisal of its occurrence is needed.
In this review, we wanted to know the pooled estimates of PBND and further, determine its pooled estimates following various PNB over time. Additionally, we also sought to estimate the incidence of PBND with or without US guidance.
A literature search was conducted in six databases. For the purposes of the review, we defined PBND as any new-onset sensorimotor disturbances in the distribution of the performed PNB either attributable to the PNB (when reported) or reported in the context of the PNB (when association with a PNB was not mentioned). Both prospective and retrospective studies which provided incidence of PBND at timepoints of interest (>48 hours to <2 weeks; >2 weeks to 6 weeks, 7 weeks to 5 months, 6 months to 1 year and >1 year durations) were included for review. Incidence data were used to provide pooled estimates (with 95% CI) of PBND at these time periods. Similar estimates were obtained to know the incidence of PBND with or without the use of US guidance. Additionally, PBND associated with individual PNB were obtained in a similar fashion with upper and lower limb PNB classified based on the anatomical location of needle insertion.
The overall incidence of PBND decreased with time, with the incidence being approximately 1% at <2 weeks' time (Incidence per thousand (95% CI)= 9 (8; to 11)) to approximately 3/10 000 at 1 year (Incidence per thousand (95% CI)= 0. 3 (0.1; to 0.5)). Incidence of PBND differed for individual PNB with the highest incidence noted for interscalene block.
Our review adds information to existing literature that the neurological complications are rarer but seem to display a higher incidence for some blocks more than others. Use of US guidance may be associated with a lower incidence of PBND especially in those PNBs reporting a higher pooled estimates. Future studies need to standardize the reporting of PBND at various timepoints and its association to PNB.
周围神经损伤或阻滞后神经功能障碍（PBND）虽不常见，但却是周围神经阻滞（PNB）的一种公认并发症。文献中报道其发生率差异较大，因此需要对其发生率进行批判性评估。
在本综述中，我们想了解 PBND 的汇总估计值，并进一步确定其随时间推移在各种 PNB 后的汇总估计值。此外，我们还试图估计有或没有超声引导时 PBND 的发生率。
在六个数据库中进行了文献检索。在本综述中，我们将 PBND 定义为在实施 PNB 的分布区域中出现的任何新的感觉运动障碍，这些障碍归因于 PNB（当报告时）或在 PNB 背景下报告（当未提及与 PNB 相关联时）。纳入了提供感兴趣时间点（>48 小时至<2 周；>2 周至 6 周、7 周至 5 个月、6 个月至 1 年和>1 年）的 PBND 发生率的前瞻性和回顾性研究。使用发生率数据提供这些时间段内 PBND 的汇总估计值（95%置信区间）。类似的估计值用于了解有或没有使用超声引导时 PBND 的发生率。此外，以类似的方式获得与个别 PNB 相关的 PBND，根据针插入的解剖位置将上肢和下肢 PNB 分类。
PBND 的总体发生率随时间降低，<2 周时的发生率约为 1%（每千例发生率（95%置信区间）= 9（8；至 11）），1 年时约为 3/10000（每千例发生率（95%置信区间）= 0.3（0.1；至 0.5））。个别 PNB 的 PBND 发生率不同，其中最高的是肌间沟阻滞。
我们的综述增加了现有文献的信息，即神经并发症较罕见，但对于某些阻滞似乎比其他阻滞更常见。超声引导的使用可能与 PBND 的发生率较低相关，尤其是在报告汇总估计值较高的那些 PNB 中。未来的研究需要标准化各种时间点的 PBND 报告及其与 PNB 的关联。
