Complications of Other Peripheral Nerve Blocks

  • Guido Fanelli
  • Andrea Casati
  • Daniela Ghisi


This chapter will discuss peripheral nerve blocks (PNBs) of the lower extremity. There are relatively few reports about complications associated with the use of PNBs in general and also about the mechanisms of injury after nerve blockade and methods to prevent them.


Nerve Injury Sciatic Nerve Nerve Block Femoral Nerve Block Peripheral Nerve Block 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Hadžić A. New York School of Regional Anesthesia.Google Scholar
  2. 2.
    Enneking FK, Chan V, Greger J, Hadžić A, Lang SA, Horlocker TT. Lower extremity peripheral nerve blockade: essentials of our understanding. Reg Anesth Pain Med 2005; 30(1):4–35.PubMedGoogle Scholar
  3. 3.
    Cheney FW. High severity injuries associated with RA in the 1990s. Am Soc Anesthesiol Newslett 2001;65:6–8.Google Scholar
  4. 4.
    Ben-David B. Complications of regional anaesthesia. Anesthesiol Clin North Am 2002; 20:427–429.Google Scholar
  5. 5.
    Fitzgibbon DR. Liability arising from anaesthesiology-based pain management in the nonoperative setting. Am Soc Anesth Newslett 2001;65:12–15.Google Scholar
  6. 6.
    Lee LA, Posner KL, Domino KB, Caplan RA, Cheney FW. Injuries associated with regional anaesthesia in the 1980s and 1990s. A closed claims analysis. Anesthesiology 2004;101:143–152.PubMedCrossRefGoogle Scholar
  7. 7.
    Auroy Y, Narchi P, Messiah A, Litt L, Rouvier B, Samii K. Serious complications related to regional anaesthesia: results of a prospective survey in France. Anesthesiology 1997; 87(3):479–486.PubMedCrossRefGoogle Scholar
  8. 8.
    Clergue F, Auroy Y, Pequignot F, Jougla E, Lienhart A, Laxenaire MC. French survey of anesthesia in 1996. Anesthesiology 1999;91(5):1509–1529.PubMedCrossRefGoogle Scholar
  9. 9.
    Auroy Y, Benhamou D, Bargues L, et al. Major complications of regional anesthesia in France: the SOS regional anesthesia hotline service. Anesthesiology 2002;97(5):1274–1280.PubMedCrossRefGoogle Scholar
  10. 10.
    Faccenda K, Finucane BT. Complications of regional anaesthesia. Drug Saf 2001;24(6):413–442.PubMedCrossRefGoogle Scholar
  11. 11.
    DiFazio CA. Adjuvant techniques to improve the success of regional anesthesia, mixtures. In: Raj PP, ed. Clinical Practice of Regional Anesthesia. New York: Churchill-Livingstone; 1991:154–160.Google Scholar
  12. 12.
    Pitcher C. Adjuvant techniques to improve the success of regional anesthesia, nerve stimulation. In: Raj PP, ed. Clinical Practice of Regional Anesthesia. New York: Churchill-Livingstone; 1991:161–169.Google Scholar
  13. 13.
    Baranowsky AP, Pither CE. A comparison of three methods of axillary brachial plexus anaesthesia. Anaesthesia 1990;45:362–365.CrossRefGoogle Scholar
  14. 14.
    Fanelli G. Peripheral nerve block with electric nerve stimulation. Minerva Anestesiol 1992;58:1025–1026.PubMedGoogle Scholar
  15. 15.
    Fanelli G, Casati A, Garancini P, Torri G. Nerve stimulator and multiple injection technique for upper and lower limb blockade: failure rate, patient acceptance and neurologic complications. Anesth Analg 1999;88(4):847–852.PubMedGoogle Scholar
  16. 16.
    Casati A, Fanelli G, Beccaria P, Magistris L, Albertin A, Torri G. The effects of single or multiple injections on the volume of 0.5% ropivacaine required for femoral nerve blockade. Anesth Analg 2001;93:183–186.PubMedCrossRefGoogle Scholar
  17. 17.
    Goldberg ME, Gregg C, Larijani GE, Norris MC, Marr AT, Seltzer JL. A comparison of three methods of axillary approach to brachial plexus blockade for upper extremity surgery. Anesthesiology 1987;66:814–816.PubMedCrossRefGoogle Scholar
  18. 18.
    Selander D, Edshage S, Wolff T. Paresthesia or no paresthesia? Acta Anaesthesiol Scand 1979;23:27–33.PubMedCrossRefGoogle Scholar
  19. 19.
    Marhofer P, Greher M, Kapral S. Ultrasound guidance in regional anaesthesia. Br J Anaesth 2005;94(1):7–17.PubMedCrossRefGoogle Scholar
  20. 20.
    La Grange P, Foster PA, Pretorius LK. Application of the Doppler ultrasound bloodflow detector in supraclavicular brachial plexus block. Br J Anaesth 1978;50:965–967.PubMedCrossRefGoogle Scholar
  21. 21.
    Greher M, Retzl G, Niel P, Kamholz L, Marhofer P, Kapral S. Ultrasonographic assessment of topographic anatomy in volunteers suggests a modification of the infraclavicular vertical brachial block. Br J Anaesth 2002;88:632–636.PubMedCrossRefGoogle Scholar
  22. 22.
    Peterson MK. Ultrasound guided nerve blocks. Br J Anaesth 2002;88:621–624.PubMedCrossRefGoogle Scholar
  23. 23.
    Fornage BD. Peripheral nerves of the extremity: imaging with ultrasound. Radiology 1988;167:179–182.PubMedGoogle Scholar
  24. 24.
    Steiner E, Nasel C. Sonography of peripheral nerves: basic principles. Acta Anaesthesiol Scand 1998;42(suppl 112):46–48.Google Scholar
  25. 25.
    Thierney E, Lewis G, Hurtig JB, Johnson D. Femoral nerve block with bupivacaine 0.25 per cent for postoperative analgesia after open knee surgery. Can J Anaesth 1987; 34:455–458.CrossRefGoogle Scholar
  26. 26.
    Marhofer P, Schrögendorfer K, Koinig H, Kapral S, Weinstabl C, Mayer N. Ultrasonographic guidance improves sensory block and onset time of three-in-one blocks. Anesth Analg 1997;85:854–857.PubMedGoogle Scholar
  27. 27.
    Marhofer P, Schrögendorfer K, Wallner T, Koinig H, Mayer N, Kapral S. Ultrasonographic guidance reduces the amount of local anesthetic for 3-in-l blocks. Reg Anesth Pain Med 1998;23:584–588.PubMedGoogle Scholar
  28. 28.
    Parkinson SK, Mueller JB, Little WL, Bailey SL. Extent of blockade with various approaches to the lumbar plexus. Anesth Analg 1989;68:243–248.PubMedGoogle Scholar
  29. 29.
    Kirchmair L, Entner T, Wissel J, Morrigl B, Kapral S, Mitterschiffthaler G. A study of the paravertebral anatomy for ultrasound-guided posterior lumbar plexus block. Anesth Analg 2001;93:477–481.PubMedGoogle Scholar
  30. 30.
    Kirchmair L, Entner T, Kapral S, Mitterschiffthaler G. Ultrasound guidance for the psoas compartment block: an imaging study. Anesth Analg 2002;94:706–710.PubMedCrossRefGoogle Scholar
  31. 31.
    Davies MJ, McGlade DP. One hundred sciatic nerve blocks: a comparison of localisation techniques. Anaesth Intensive Care 1993;21:76–78.PubMedGoogle Scholar
  32. 32.
    Morris GF, Lang SA, Dust WN, Van der Wal M. The parasacral sciatic nerve block. Reg Anesth 1997;22:223–228.PubMedCrossRefGoogle Scholar
  33. 33.
    Marhofer P, Greher M, Kapral S. Ultrasound guidance in regional anaesthesia. Br J Anaesth 2005;94:7–17.PubMedCrossRefGoogle Scholar
  34. 34.
    Kroll DA, Caplan RA, Posner K, et al. Nerve injury associated with anesthesia. Anesthesiology 1990;73:202–207.PubMedCrossRefGoogle Scholar
  35. 35.
    Liguori GA. Complications of regional anesthesia. Nerve injury and peripheral neural blockade. J Neurosurg Anesthesiol 2004;16:84–86.PubMedCrossRefGoogle Scholar
  36. 36.
    Schroeder LE, Horlocker TT, Schroeder DR. The efficacy of axillary block for surgical procedures about the elbow. Anesth Analg 1996;83:747–751.PubMedGoogle Scholar
  37. 37.
    Horlocker TT, Kufner RP, Bishop AT, et al. The risk of persistent paresthesia is not increased with repeated axillary block. Anesth Analg 1999;88:382–387.PubMedGoogle Scholar
  38. 38.
    Stan TC, Krantz MA, Solomon DL, et al. The incidence of neurovascular complications following axillary brachial plexus block using a transarterial approach. Reg Anesth 1995;20: 486–492.PubMedGoogle Scholar
  39. 39.
    Urban MK, Urquart B. Evaluation of brachial plexus anesthesia for upper extremity surgery. Reg Anesth 1994;19:175–182.PubMedGoogle Scholar
  40. 40.
    Borgeat A, Ekatodramis G, Kalberer F, et al. Acute and non acute complications associated with interscalene block and shoulder surgery. A prospective study. Anesthesiology 2001;95:875–880.PubMedCrossRefGoogle Scholar
  41. 41.
    Hartung HJ, Rupprecht A. The axillary brachial plexus block: a study of 178 patients. Reg Anaesth 1989;12:21–24.PubMedGoogle Scholar
  42. 42.
    Benumoff JL. Permanent loss of cervical spinal cord function associated with interscalene block performed under general anesthesia. Anesthesiology 2000;93:1541–1544.CrossRefGoogle Scholar
  43. 43.
    Kalichman MW, Powell HC, Myers RR. Quantitative histologic analysis of local anesthetic-induced injury to rat sciatic nerve. J Pharmacol Exp Ther 1989;20: 406–413.Google Scholar
  44. 44.
    Seiander D, Brattsand R, Lundborg G, et al. Local anesthetics: importance of mode of application, concentration, and adrenaline for the appearance of nerve lesions — an experimental study of axonal degeneration and barrier damage after intrafascicular injection or topical application of bupivacaine (Marcain). Acta Anaesthesiol Scand 1979;23: 127–136.CrossRefGoogle Scholar
  45. 45.
    Selander D, Mansson LG, Karlsson L, Svanvik J. Adrenergic vasoconstriction in peripheral nerves of the rabbit. Anesthesiology 1985;62:6–10.PubMedCrossRefGoogle Scholar
  46. 46.
    Ben-David B. Complications of peripheral blockade. Anesthesiol Clin North Am 2002;20: 695–707.CrossRefGoogle Scholar
  47. 47.
    Komorowski TE, Shepard B, Okland S, Carlson BM. An electron microscopic study of local anesthetic-induced skeletal muscle fibre degeneration and regeneration in the monkey. J Orthop Res 1990;8:495–503.PubMedCrossRefGoogle Scholar
  48. 48.
    Yagiela JA, Benoit PW, Buoncristiani RD, et al. Comparison of myotoxic effects of lidocaine with epinephrine in rats and humans. Anesth Analg 1981;60:471–480.PubMedCrossRefGoogle Scholar
  49. 49.
    Pham-Dang C, Beaumont S, Floch H, Bodin J, Winer A, Pinaud M. Acute toxicity accident following lumbar plexus block with bupivacaine [French]. Ann Fr Anesth Reanim 2000;19:356–359.PubMedCrossRefGoogle Scholar
  50. 50.
    Breslin DS, Martin G, Macleod DB, D’Ercole F, Grant SA. Central nervous system toxicity following the administration of levobupivacaine for lumbar plexus block: a report of two cases. Reg Anesth Pain Med 2003;28:144–147.PubMedGoogle Scholar
  51. 51.
    Mullanu C, Gaillat F, Scemama F, Thibault S, Lavand’homme P, Auffray J P. Acute toxicity of local anesthetic ropivacaine and mepivacaine during combined lumbar plexus and sciatic block for hip surgery. Acta Anesthesiol Belg 2002;53:221–223.Google Scholar
  52. 52.
    Petitjeans F, Mion G, Puidupin M, Tourtier JP, Hutson C, Saissy JM. Tachycardia and convulsions induced by accidental intravascular ropivacaine injection during sciatic block. Acta Anaesthesiol Scand 2002;46:616–617.PubMedCrossRefGoogle Scholar
  53. 53.
    Brown DL, Ransom DM, Hall JA, Leicht CH, Schroeder DR, Offord KP. Regional anesthesia and local anesthetic induced systemic toxicity: seizure frequency and accompanying cardiovascular changes. Anesth Analg 1995;81:321–328.PubMedGoogle Scholar
  54. 54.
    Cuvillon P, Ripart J, Lalourcey L, et al. The continuous femoral nerve block catheter for postoperative analgesia: bacteria colonization, infectious rate and adverse effects. Anesth Analg 2001;93:1045–1049.PubMedCrossRefGoogle Scholar
  55. 55.
    Jöhr M. A complication of continuous femoral nerve block [German]. Reg Anaesth 1987;10: 37–38.PubMedGoogle Scholar
  56. 56.
    Capdevila X, Barthelet Y, Biboulet P, Ryckwaert Y, Rubenovitch J, D’Athis F. Effects of perioperative analgesic technique on the surgical outcome and duration of rehabilitation after major knee surgery. Anesthesiology 1999;91:8–15.PubMedCrossRefGoogle Scholar
  57. 57.
    Weller RS, Gerancher JC, Crews JC, Wade KL. Extensive retroperitoneal hematoma without neurologic deficit in two patients who underwent lumbar plexus block and were later anticoagulated. Anesthesiology 2003;98:581–585.PubMedCrossRefGoogle Scholar
  58. 58.
    Aveline C, Bonnet F. Delayed retroperitoneal haematoma after failed lumbar plexus block. Br J Anaesth 2004;93(4):589–591.CrossRefGoogle Scholar
  59. 59.
    Klein SM, D’Ercole F, Greengrass RA, Warner DS. Enoxaparin associated with psoas hematoma and lumbar plexopathy after lumbar plexus block. Anesthesiology 1997;87: 1576–1579.PubMedCrossRefGoogle Scholar
  60. 60.
    Aromaa U, Lahdensuu M, Cazanitis DA. Severe complications associated with epidural and spinal anaesthesias in Finland 1987–1993. A study based on patient insurance claims. Acta Anaesthesiol Scand 1997;41:445–452.PubMedCrossRefGoogle Scholar
  61. 61.
    Wang LP, Hauerberg J, Schmidt JF. Incidence of spinal epidural abscess after epidural analgesia. Anaesthesiology 1999;91:1928–1936.CrossRefGoogle Scholar
  62. 62.
    Bergamnn BD, Hebl JR, Kent J, Horlocker TT. Neurologic complications of 405 consecutive continuous axillary catheters. Anesth Analg 2003;96:247–252.Google Scholar
  63. 63.
    Adam F, Jaziri S, Chauvin M. Psoas abscess complicating femoral nerve block catheter. Anesthesiology 2003;99:230–231.PubMedCrossRefGoogle Scholar
  64. 64.
    Cuvillon P, Ripart J, Lalourcey L, et al. The continuous femoral nerve block catheter for postoperative analgesia: bacterial colonization, infectious rate and adverse effects. Anesth Analg 2001;93:1045–1049.PubMedCrossRefGoogle Scholar
  65. 65.
    Hebl JR, Horlocker TT. You’re not as clean as you think! The role of asepsis in reducing infectious complications related to regional anesthesia. Reg Anesth Pain Med 2003;28(5):376–379.PubMedGoogle Scholar
  66. 66.
    Bernstein IT, Hansen BJ. Iatrogenic psoas abscess. Case report. Scand J Urol Nephrol 1991;25:85–86.PubMedCrossRefGoogle Scholar
  67. 67.
    Sato S, Sakuragi T, Dan K. Human skin flora as a potential source of epidural abscess. Anesthesiology 1996;85:1276–1282.PubMedCrossRefGoogle Scholar
  68. 68.
    Saloojee H, Steenhoff A. The health professional’s role in preventing nosocomial infections. Postgrad Med J 2001;77:16–19.PubMedCrossRefGoogle Scholar
  69. 69.
    Cheney FW, Domino KB, Caplan RA, Posner KL. Nerve injury associated with anesthesia: a closed claims analysis. Anesthesiology 1999;90:1062–1069.PubMedCrossRefGoogle Scholar
  70. 70.
    Warner MA, Warner DO, Harper CM, Schroeder DR, Maxson PM. Lower extremity neuropathies associated with lithotomy positions. Anesthesiology 2000;93:938–942.PubMedCrossRefGoogle Scholar
  71. 71.
    Gruson KI, Moed BR. Injury of the femoral nerve associated with acetabular fracture. J Bone Joint Surg [Am] 2003;85A:428–431.Google Scholar
  72. 72.
    Slater N, Singh R, Senasinghe N, Gore R, Goroszeniuk T, James D. Pressure monitoring of the femoral nerve during total hip replacement: an explanation for iatropathic palsy. J R Coll Surg Edinb 2000;45:231–233.PubMedGoogle Scholar
  73. 73.
    Finsen V, Kasseth AM. Tourniquets in forefoot surgery: less pain when placed at the ankle. J Bone Joint Surg [Br] 1997;79:99–101.CrossRefGoogle Scholar
  74. 74.
    Schurman DJ. Ankle block anesthesia for foot surgery. Anesthesiology 1976;44: 348–352.PubMedCrossRefGoogle Scholar
  75. 75.
    Lichtenfeld NS. The pneumatic ankle tourniquet with ankle block anesthesia for foot surgery. Foot Ankle 1992;13:344–349.PubMedGoogle Scholar
  76. 76.
    Barber FA, Click J, Britt BT. Complications of ankle arthroscopy. Foot Ankle 1990;10: 263–266.PubMedGoogle Scholar
  77. 77.
    Ferkel RD, Heath DD, Guhl J F. Neurological complications of ankle arthroscopy. Arthroscopy 1996;12:200–208.PubMedCrossRefGoogle Scholar
  78. 78.
    Shevde K, Panagopoulos G. A survey of 800 patients’ knowledge attitudes and concerns regarding anesthesia. Anesth Analg 1991;73:190–198.PubMedCrossRefGoogle Scholar
  79. 79.
    Hadžić A, Vloka JD, Kuroda MM, Koorn R, Birnbach DJ. The practice of peripheral nerve blocks in the United States: a national survey. Reg Anesth Pain Med 1998;23(3):241–246.PubMedGoogle Scholar
  80. 80.
    Katz J. A survey of anesthetic choice among anesthesiologists. Anesth Analg 1973;52: 373–375.PubMedGoogle Scholar
  81. 81.
    Broadman LM, Mesrobian R, Ruttimann U, McGill WA. Do anesthesiologists prefer a regional or a general anesthetic for themselves? [abstract] Reg Anesth 1985;11:57.Google Scholar
  82. 82.
    Buffington CW, Ready LB, Horton WG. Training and practice factors influence the use of regional anesthesia. Implications for resident education. Reg Anesth 1985;10: 2–6.Google Scholar
  83. 83.
    Bridenbaugh LD. Are anesthesia resident programs failing regional anesthesia? Reg Anesth 1982;7:26–28.Google Scholar
  84. 84.
    Kopacz DJ, Bridenbaugh LD. Are anesthesia residency training programs failing regional anesthesia? The past, present and future. Reg Anesth 1993;18:84–87.PubMedGoogle Scholar
  85. 85.
    Kopacz DJ, Neal JM. Regional anesthesia and pain medicine: residency training — the year 2000. Reg Anesth Pain Med 2002;27(1):9–14.PubMedGoogle Scholar
  86. 86.
    Chelly JE, Greger J, Gebhard R, Hagberg CA, Al-Samsam T, Khan A. Training of residents in peripheral nerve blocks during anaesthesiology residency. J Clin Anesth 2002;14(8):584–588.PubMedCrossRefGoogle Scholar
  87. 87.
    Buist RJ. A survey of the practice of regional anaesthesia. J R Soc Med 1990;83:709–712.PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2007

Authors and Affiliations

  • Guido Fanelli
    • 1
  • Andrea Casati
    • 1
  • Daniela Ghisi
    • 1
  1. 1.Department of Anesthesia and Pain TherapyUniversity of ParmaParmaItaly

Personalised recommendations