ASRA Practice Advisory on Neurologic Complications in Regional Anesthesia and Pain Medicine

Department of Anesthesiology, Virginia Mason Medical Center, Seattle, WA, USA.
Regional anesthesia and pain medicine (Impact Factor: 3.09). 09/2008; 33(5):404-15. DOI: 10.1016/j.rapm.2008.07.527
Source: PubMed


Neurologic complications associated with regional anesthesia and pain medicine practice are extremely rare. The ASRA Practice Advisory on Neurologic Complications in Regional Anesthesia and Pain Medicine addresses the etiology, differential diagnosis, prevention, and treatment of these complications. This Advisory does not focus on hemorrhagic and infectious complications, because they have been addressed by other recent ASRA Practice Advisories. The current Practice Advisory offers recommendations to aid in the understanding and potential limitation of neurologic complications that may arise during the practice of regional anesthesia and pain medicine.

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    • "Up to 8% of neurological symptoms, reported on the 8th postoperative day after shoulder surgery are attributed to it. The guidelines by American Society of Regional Anaesthesia accord a clear recommendation regarding the use of ISB.[10] Among the various strategies proposed to limit the respiratory impact of analgesic strategies to shoulder surgeries include supraclavicular nerve block and reduced volume of local anaesthetics.[7] "
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    ABSTRACT: We report the anaesthetic management of two cases involving surgeries on the clavicle, performed under superficial cervical plexus block and selective C5 nerve root block under ultrasound (US) guidance, along with general anaesthesia. Regional analgesia for clavicular surgeries is challenging. Our patients also had significant comorbidities necessitating individualised approach. The first patient had a history of emphysema, obesity, and was allergic to morphine and hydromorphone. The second patient had clavicular arthritis and pain due to previous surgeries. He had a history of smoking, Stevens-Johnson syndrome, along with daily marijuana and prescription opioid use. Both patients had an effective regional block and required minimal supplementation of analgesia, both being discharged on the same day. Interscalene block with its associated risks and complications may not be suitable for every patient. This report highlights the importance of selective regional blockade and also the use of US guidance for an effective and safe block.
    Indian journal of anaesthesia 05/2014; 58(3):327-9. DOI:10.4103/0019-5049.135050
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    • "The paralysis of the limb induced by A-β fibers blockade cannot be accepted for a long period due to risk of sore lesions, loss of muscle mass hindering rehabilitation, and masking of complications. Indeed, complications of nerve blockade (nerve injury, hematoma, infection) are suspected when a motor deficit appears or persists [79]. "
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    ABSTRACT: Peripheral and neuraxial nerve blockades are widely used in the perioperative period. Their values to diminish acute postoperative pain are established but other important outcomes such as chronic postoperative pain, or newly, cancer recurrence, or infections could also be influenced. The long-term effects of perioperative nerve blockade are still controversial. We will review current knowledge of the effects of blocking peripheral electrical activity in different animal models of pain. We will first go over the mechanisms of pain development and evaluate which types of fibers are activated after an injury. In the light of experimental results, we will propose some hypotheses explaining the mitigated results obtained in clinical studies on chronic postoperative pain. Finally, we will discuss three major disadvantages of the current blockade: the absence of blockade of myelinated fibers, the inappropriate duration of blockade, and the existence of activity-independent mechanisms.
    Anesthesiology Research and Practice 07/2011; 2011(1687-6962):124898. DOI:10.1155/2011/124898
    • "This is based on the “double-crush” phenomenon. This suggests that patients with preexisting neural compromise may be more susceptible to injury at another site when exposed to a secondary insult.23 "
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    ABSTRACT: While patients with obstructive sleep apnea (OSA) or multiple sclerosis (MS) are at high risk of developing postoperative complications, both of them have special anesthetic considerations in intraoperative and postoperative periods. A careful preoperative evaluation, use of the optimal anesthetic regimen and close postoperative care is essential for these patients. Rarity of coexistence of both obstructive sleep apnea and multiple sclerosis in a surgical patient necessitates careful anesthetic management. We here report anesthetic management of a female patient with OSA and MS who underwent anesthesia three times for surgery and review the literature.
    Journal of research in medical sciences 06/2011; 16(6):828-35. · 0.65 Impact Factor
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