University Hospital Antwerp, Belgium

The incidence of wrong-sided blocks varies in the literature between 0,5–5 per 10.000 blocks. Blocking the wrong side seems avoidable and is often considered as the result of inattention or carelessness. However, several factors seem to contribute to this event, as for all medical errors (described as the swiss cheese model).

Although the consequences of the block itself may not be life threatening, it might lead to wrong sided surgery as a possible harm.

Several methods are available for preventing wrong-sided nerve blocks, for example the stop before you block, the surgical preoperative checklist and preoperative obliged marking of the operative side by the surgeon. Implementing these strategies can greatly lower the incidence of wrong sided nerve blocks.

The block room as a designated space saves OR time and provides a more relaxing environment for both the anesthetist and the patient. It is not clear whether the time saving benefits outweigh the cost of the block room itself. This depends on the institution and the kind of surgery for which it is used.

There are several strategies available for both preventing wrong-sided blocks and optimalisation of the block room. However optimal implementation calls upon our non-technical skills. ‘Change Management’, especially in a medical environment is challenging. Teamwork, Education, Communication, Situational awareness, and knowledge of group dynamics are all important skills that contribute to preventing errors, optimal patient flow and quality of care.

References

1. Reason J. Human error: models and management. BMJ 2000; (7237):768–70.

2. Kwofie K, Uppal V. Wrong-site nerve blocks: evidence-review and prevention strategies. Curr Opin Anaesthesiol 2020;33(5):698–703.

3. Ilfeld BM, Liguori GA. Regional anesthesia ‘block rooms’: should they be universal? Look to goldilocks (and her 3 bears) for the answer. Reg Anesth Pain Med 2017;