Neurological injury following peripheral nerve blocks: a narrative review of estimates of risks and the influence of ultrasound guidance.

Autor:	Lemke E; Emergency Medicine, University of Michigan Health-West, Wyoming, Michigan, USA., Johnston DF; Department of Anaesthesia, Belfast Health and Social Care Trust, Belfast, Northern Ireland, UK., Behrens MB; Department of Emergency Medicine, Kent Hospital, Warwick, Rhode Island, USA., Seering MS; Department of Anesthesia, University of Iowa Healthcare, Iowa City, Iowa, USA., McConnell BM; Davis Library, University of Waterloo, Waterloo, Ontario, Canada., Swaran Singh TS; Department of Anesthesia, University of Iowa Healthcare, Iowa City, Iowa, USA., Sondekoppam RV; Department of Anesthesia, University of Iowa Healthcare, Iowa City, Iowa, USA rakesh6282@gmail.com.
Jazyk:	angličtina
Zdroj:	Regional anesthesia and pain medicine [Reg Anesth Pain Med] 2024 Feb 05; Vol. 49 (2), pp. 122-132. Date of Electronic Publication: 2024 Feb 05.
DOI:	10.1136/rapm-2023-104855
Abstrakt:	Background: 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. Objective: 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. Evidence Review: 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. Findings: 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. Conclusions: 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. Competing Interests: Competing interests: RVS: receives consultation fees from CIVCO Ltd and the relationship is currrent. (© American Society of Regional Anesthesia & Pain Medicine 2024. No commercial re-use. See rights and permissions. Published by BMJ.)
Databáze:	MEDLINE
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