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The Second ASRA Practice Advisory on Neurologic Complications Associated With Regional Anesthesia and Pain Medicine: Executive Summary 2015
  1. Joseph M. Neal, MD*,
  2. Michael J. Barrington, MBBS, FANZCA, PhD,
  3. Richard Brull, MD,
  4. Admir Hadzic, MD§,
  5. James R. Hebl, MD,
  6. Terese T. Horlocker, MD,
  7. Marc A. Huntoon, MD**,
  8. Sandra L. Kopp, MD,
  9. James P. Rathmell, MD†† and
  10. James C. Watson, MD
  1. From the *Departments of Anesthesiology and Neurology, Virginia Mason Medical Center, Seattle, WA; †University of Melbourne, Melbourne, Victoria, Australia; ‡University of Toronto, Toronto, Ontario, Canada; §Ziekenhuis Oost-Limburg, Genk, Belgium; ∥Mayo Clinic College of Medicine, Rochester, MN; **Vanderbilt School of Medicine, Nashville, TN; and ††Harvard Medical School; Boston, MA
  1. Address correspondence to: Joseph M. Neal, MD, 1100 Ninth Ave (B2-AN) Seattle, WA 98101 (e-mail: Joseph.Neal{at}virginiamason.org).

Abstract

Neurologic injury associated with regional anesthetic or pain medicine procedures is extremely rare. The Second American Society of Regional Anesthesia and Pain Medicine Practice Advisory on Neurologic Complications Associated With Regional Anesthesia and Pain Medicine focuses on those complications associated with mechanical, ischemic, or neurotoxic injury of the neuraxis or peripheral nervous system. As with the first advisory, this iteration does not focus on hemorrhagic or infectious complications or local anesthetic systemic toxicity, all of which are the subjects of separate practice advisories. The current advisory offers recommendations to aid in the understanding and potential limitation of rare neurologic complications that may arise during the practice of regional anesthesia and/or interventional pain medicine.

What’s New The Second American Society of Regional Anesthesia and Pain Medicine Practice Advisory on Neurologic Complications Associated With Regional Anesthesia and Pain Medicine updates information that was originally presented at the Society’s first open forum on this subject (2005) and published in 2008. Portions of the second advisory were presented in an open forum (2012) and are herein updated, with attention to those topics subject to evolving knowledge since the first and second advisory conferences. The second advisory briefly summarizes recommendations that have not changed substantially. New to this iteration of the advisory is information related to the risk of nerve injury inherent to common orthopedic surgical procedures. Recommendations are expanded regarding the preventive role of various monitoring technologies such as ultrasound guidance and injection pressure monitoring. New clinical recommendations focus on emerging concerns including spinal stenosis and vertebral canal pathologies, blood pressure management during neuraxial anesthesia, administering blocks in anesthetized or deeply sedated patients, patients with preexisting neurologic disease, and inflammatory neuropathies. An updated diagnostic and treatment algorithm is presented.

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Footnotes

  • Portions of this article were presented as part of the American Society of Regional Anesthesia and Pain Medicine’s Second Practice Advisory on Neurological Complications in Regional Anesthesia and Pain Medicine, San Diego, California, March 16, 2012.

    The American Society of Regional Anesthesia and Pain Medicine provided standard travel reimbursement for members of the advisory who presented this work in open forum as part of the Society’s 37th Annual Regional Anesthesiology and Acute Pain Medicine meeting in San Diego, California, March 16, 2012. No panelist was paid for participation in the practice advisory process.

    Dr Hadzic receives royalty payments from BBraun Medical for the BSmart injection pressure monitoring device. No other author has a conflict of interest related to the subject matter of this article.

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