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Practice Patterns Related to Block Selection, Nerve Localization and Risk Disclosure: A Survey of the American Society of Regional Anesthesia and Pain Medicine
  1. Richard Brull, M.D., F.R.C.P.C.a,
  2. Dhuleep S. Wijayatilake, M.B.B.S., F.R.C.A.a,
  3. Anahi Perlas, M.D., F.R.C.P.C.a,
  4. Vincent W.S. Chan, M.D., F.R.C.P.C.a,
  5. Sherif Abbas, M.D.a,
  6. Gregory A. Liguori, M.D.b,
  7. Mary J. Hargett, B.Sc.b and
  8. Hossam El-Beheiry, M.B.B.Ch., Ph.D., F.R.C.P.C.a
  1. aDepartment of Anesthesia and Pain Management, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
  2. bDepartment of Anesthesiology, Hospital for Special Surgery, Weill-Cornell Medical College, New York, NY


Background and Objectives: We aimed to identify current clinical practice patterns among members of the American Society of Regional Anesthesia and Pain Medicine (ASRA) members that relate to complications of regional anesthesia (RA).

Methods: Invitations were posted to the 3,732 ASRA members, to participate in our survey. Members were asked to report the types and numbers of blocks performed annually, preferred nerve localization techniques, and routine risk disclosure practices prior to common neuraxial (NAB) and peripheral nerve (PNB) block techniques.

Results: The number of respondents was 801 (response rate: 21.7%). Approximately half of the respondents perform >100 spinal and epidural blocks but <50 of each listed PNB annually. With the exception of axillary block, nerve stimulation is the overwhelmingly preferred nerve localization technique for PNB. Five hundred twenty-nine respondents (66.2%) disclose of RA primarily to allow patients to make an informed choice, while 227 (28.4%) disclose for medicolegal reasons. For NAB, the most commonly disclosed risks are headache and local pain/discomfort. Neurological complications following NAB such as permanent neuropathy and paralysis are inconsistently disclosed. For PNB, the most commonly disclosed risks are local pain/discomfort and transient neuropathy. The least commonly disclosed risks for both NAB and PNB include seizures, respiratory failure, cardiac arrest, and death. With the exception of headache following spinal anesthesia (1:100) and Horner's syndrome following interscalene block (1:10), there is little consensus regarding the perceived incidence of complications.

Conclusions: Based on a 22% response rate, our survey suggests that the risks of RA most commonly disclosed to patients by ASRA members are benign while severe complications of RA are far less commonly disclosed. There is little agreement among ASRA members regarding their perceived incidence of complications following RA.

  • Adverse effects
  • Anesthesia
  • Epidural
  • Spinal
  • Nerve block
  • Postoperative complications

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  • Reprint requests: Richard Brull, M.D., F.R.C.P.C., Department of Anesthesia and Pain Management, Toronto Western Hospital, 399 Bathurst Street, Toronto, M5T 2S8 Ontario, Canada. E-mail: richard.brull{at}