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Preprocedural checklist for regional anesthesia: impact on the incidence of wrong site nerve blockade (an 8-year perspective)
  1. Daryl S Henshaw,
  2. James D Turner,
  3. Sean W Dobson,
  4. Jonathan Douglas Jaffe,
  5. John Wells Reynolds,
  6. Christopher J Edwards and
  7. Robert S Weller
  1. Department of Anesthesiology, Section on Regional Anesthesia and Acute Pain Management, Wake Forest School of Medicine, Winston Salem, North Carolina, USA
  1. Correspondence to Daryl S Henshaw, Department of Anesthesiology, Wake Forest School of Medicine, Winston Salem, NC 27157, USA; dhenshaw{at}


Background The term “Wrong-Site Surgery (WSS)” is commonly associated with surgical procedures; however, The Joint Commission (TJC) considers any invasive procedure, not just a surgical procedure, performed on the wrong side, at the wrong site, or on the wrong patient to be a WSS. For anesthesia providers, this means that a wrong-site nerve block (WSNB) also constitutes a WSS and would be considered a sentinel event by TJC. In an attempt to combat WSNB, the American Society of Regional Anesthesia and Pain Medicine published guidelines in 2014 recommending the use of a preprocedural checklist before performing regional blocks. The effectiveness of such a checklist, however, to reduce the occurrence of WSNB has not yet been demonstrated. We hypothesized that the introduction of a preprocedural checklist specific for regional anesthesia would be associated with a lower rate of WSNB procedures.

Methods A retrospective review was performed to compare the incidence of WSNB 2 years before, to 6 years after the implementation of a preprocedural checklist specific to regional anesthesia.

Results Prior to checklist implementation, 4 WSNB events occurred during 10 123 procedures (3.95 per 10 000 (95% CI 1.26 to 9.53). Following implementation, WSNB events occurred during 35 890 procedures (0 per 10 000 (95% CI 0 to 0.84)); p=0.0023.

Conclusions Implementation of a regional anesthesia specific preprocedural checklist was associated with a significantly lower incidence of WSNB procedures. While prospective controlled studies would be required to demonstrate causation, this study suggests that for regional anesthesia procedures, a preprocedural checklist may positively impact patient safety.

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  • Presented at Interim data from this work were presented at the 2018 World Congress on Regional Anesthesia & Pain Medicine in New York, NY, April 19–21, 2018.

  • Competing interests None declared.

  • Ethics approval Institutional review board (IRB) approval was obtained prior to study initiation and the need for informed consent was formally waived (Wake Forest University Health Sciences, # 00048477)