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Neurological injury following peripheral nerve blocks: a narrative review of estimates of risks and the influence of ultrasound guidance
  1. Ethan Lemke1,
  2. David F Johnston2,
  3. Matthew B Behrens3,
  4. Melinda S Seering4,
  5. Brie M McConnell5,
  6. Tejinder Singh Swaran Singh4 and
  7. Rakesh V Sondekoppam4
  1. 1Emergency Medicine, University of Michigan Health-West, Wyoming, Michigan, USA
  2. 2Department of Anaesthesia, Belfast Health and Social Care Trust, Belfast, Northern Ireland, UK
  3. 3Department of Emergency Medicine, Kent Hospital, Warwick, Rhode Island, USA
  4. 4Department of Anesthesia, University of Iowa Healthcare, Iowa City, Iowa, USA
  5. 5Davis Library, University of Waterloo, Waterloo, Ontario, Canada
  1. Correspondence to Dr Rakesh V Sondekoppam, Department of Anesthesia, University of Iowa Healthcare, Iowa City, Iowa 52240, USA; rakesh6282{at}


Background Peripheral nerve injury or post-block neurological dysfunction (PBND) are uncommon but a recognized complications of peripheral nerve blocks (PNB). A broad range of its incidence is noted in the literature and hence a critical appraisal of its occurrence is needed.

Objective In this review, we wanted to know the pooled estimates of PBND and further, determine its pooled estimates following various PNB over time. Additionally, we also sought to estimate the incidence of PBND with or without US guidance.

Evidence review A literature search was conducted in six databases. For the purposes of the review, we defined PBND as any new-onset sensorimotor disturbances in the distribution of the performed PNB either attributable to the PNB (when reported) or reported in the context of the PNB (when association with a PNB was not mentioned). Both prospective and retrospective studies which provided incidence of PBND at timepoints of interest (>48 hours to <2 weeks; >2 weeks to 6 weeks, 7 weeks to 5 months, 6 months to 1 year and >1 year durations) were included for review. Incidence data were used to provide pooled estimates (with 95% CI) of PBND at these time periods. Similar estimates were obtained to know the incidence of PBND with or without the use of US guidance. Additionally, PBND associated with individual PNB were obtained in a similar fashion with upper and lower limb PNB classified based on the anatomical location of needle insertion.

Findings The overall incidence of PBND decreased with time, with the incidence being approximately 1% at <2 weeks’ time (Incidence per thousand (95% CI)= 9 (8; to 11)) to approximately 3/10 000 at 1 year (Incidence per thousand (95% CI)= 0. 3 (0.1; to 0.5)). Incidence of PBND differed for individual PNB with the highest incidence noted for interscalene block.

Conclusions Our review adds information to existing literature that the neurological complications are rarer but seem to display a higher incidence for some blocks more than others. Use of US guidance may be associated with a lower incidence of PBND especially in those PNBs reporting a higher pooled estimates. Future studies need to standardize the reporting of PBND at various timepoints and its association to PNB.

  • Anesthesia, Conduction
  • Anesthesia, Local
  • Nerve Block
  • Peripheral Nerve Injuries

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  • Twitter @davejohnston24, @rakesh6282

  • Presented at The current study was presented at the 48th Annual meeting of the American Society of Regional Anesthesia and Pain Medicine (ASRA) and was one of the featured abstracts of the meeting (President’s Choice award)

  • Contributors RVS, EL, MBB, BMM and DJ provided substantial contributions to the conception or design of the work, the acquisition, analysis and interpretation of data for the work. RVS, DJ and BMM provided significant contributions to drafting the work and, MS and TSSS contributed by revising it critically for important intellectual content. RVS, DJ, BMM and MS helped in revisions. RVS and DJ provided final approval of the version to be submitted. RVS has agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Disclaimer RVS has ongoing consultant role with CIVCO medical systems.

  • Competing interests RVS: receives consultation fees from CIVCO Ltd and the relationship is currrent.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.