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Peripheral nerve blocks are not associated with increased risk of perioperative peripheral nerve injury in a Veterans Affairs inpatient surgical population
  1. Meghana Yajnik1,
  2. Alex Kou1,2,
  3. Seshadri C Mudumbai1,2,
  4. Tessa L Walters1,2,
  5. Steven K Howard1,2,
  6. T Edward Kim1,2 and
  7. Edward R Mariano1,2
  1. 1 Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California, USA
  2. 2 Anesthesiology and Perioperative Care Service, Veterans Affairs Palo Alto Health Care System, Palo Alto, California, USA
  1. Correspondence to Edward R Mariano, Department of Anesthesiology and Perioperative Care Service, VA Palo Alto Health Care System, Palo Alto, CA 94304, USA; emariano{at}


Background and objectives Perioperative peripheral nerve injury (PNI) is a known complication in patients undergoing surgery with or without regional anesthesia. The incidence of new PNI in a Veterans Affairs (VA) inpatient surgical population has not been previously described; therefore, the incidence, risk factors, and clinical course of new PNI in this cohort are unknown. We hypothesized that peripheral nerve blocks do not increase PNI incidence.

Methods We conducted a 5-year review of a Perioperative Surgical Home database including all consecutive surgical inpatients. The primary outcome was new PNI between groups that did or did not have peripheral nerve blockade. Potential confounders were first examined individually using logistic regression, and then included simultaneously together within a mixed-effects logistic regression model. Electronic records of patients with new PNI were reviewed for up to a year postoperatively.

Results The incidence of new PNI was 1.2% (114/9558 cases); 30 of 3380 patients with nerve block experienced new PNI (0.9%) compared with 84 of 6178 non-block patients (1.4%; p=0.053). General anesthesia alone, younger age, and American Society of Anesthesiologists physical status <3 were associated with higher incidence of new PNI. Patients who received transversus abdominis plane blocks had increased odds for PNI (OR, 3.20, 95% CI 1.34 to 7.63), but these cases correlated with minimally invasive general and urologic surgery. One hundred PNI cases had 1-year follow-up: 82% resolved by 3 months and only one patient did not recover in a year.

Conclusions The incidence of new perioperative PNI for VA surgical inpatients is 1.2% and the use of peripheral nerve blocks is not an independent risk factor.

  • regional anesthesia
  • peripheral nerve block
  • complications
  • nerve injury
  • patient safety

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  • Presented at This work was presented in part at the 2018 World Congress on Regional Anesthesia and Acute Pain Medicine Meeting, April 19–21, 2018, New York, New York.

  • Twitter New study by @EMARIANOMD: "Peripheral Nerve Blocks Are Not Associated with Increased Risk of Perioperative Peripheral Nerve Injury in a Veterans Affairs Inpatient Surgical Population"

  • Competing interests None of the authors has any conflicts of interest to declare.

  • Ethics approval This retrospective cohort study was reviewed and approved with waiver of informed consent by the local institutional review board (Stanford, California) and Veterans Affairs (VA) Research Committee (Palo Alto, California).

  • Provenance and peer review Not Commissioned; Externally peer reviewed.