Table 3

Nerve injuries after lower extremity nerve blocks

StudyNature of studyResultsComments
Lee et al (2004)285 Data based on claims involving nerve injuries1005 regional anesthesia claims.
Peripheral nerve blocks accounted for 13% of claims; permanent damage associated with 29% of claims (1% femoral/sciatic nerves).
Claims involving lower extremity blocks low in comparison to upper extremity blocks (1% of claims involved lower extremity compared with 28% with upper extremity blocks). However, data reflect an era where lower extremity nerve bocks were less popular and performed mostly with PNS.
Auroy et al (1997)282Prospective survey of regional anesthesia complications; 5-month study period; 736 anesthesiologists21 278 peripheral nerve blocks.
Four cases of radiculopathy (specific nerve block not stated).
Nerve blocks mostly performed with PNS.
Two thirds of patients with neurologic deficits had either paresthesia during needle placement or pain on injection.
Auroy et al (2002)268 Prospective survey; 10-month study period; 487 participants50 223 peripheral nerve blocks.
Peripheral neuropathy: femoral (3/10 309), sciatic (2/8507), popliteal (3/952).
Nerve blocks mostly performed with PNS.
Seven of 12 patients had persistent neuropathy after 6 months; neurologic complications noted when there was concomitant paresthesia (2/12), use of neurostimulation (9/12) or stimulatory threshold below 0.5 mA (3/12).
Capdevila et al (2005)286 Prospective study on continuous peripheral nerve blocks1416 patients.
Patients with nerve lesions: femoral (3/683), fascia iliaca (0/94), sciatic (0/32), popliteal (0/167), distal (1/38).
In 2 of 3 femoral neuropathies, the blocks were done while the patients were anesthetized. One patient reported sharp pain on injection. Complete resolution occurred in 36 hours, at 6 weeks, and at 10 weeks.
Compere et al (2009)283 Prospective study on continuous popliteal sciatic nerve blocks; 400 patients over a 2-month periodMedian time of catheter usage: 47 hours.
Two cases of neuropathy (0.5%).
Paresthesia in the superficial peroneal nerve distribution; beyond 18 months in one patient (paresthesia reported during nerve localization).
Brull et al (2007)284 Review of 32 published studies between 1 January 1995 and 31 December 2005Rate of neuropathy after femoral nerve blocks: 0.34:100 (95% CI 0.04 to 2.81:100).Only 1 case of permanent neuropathy reported among 16 studies.
Barrington et al (2009)269 Prospective study of complications after peripheral nerve blocks, January 2006–May 20087156 peripheral nerve blocks in 6069 patients.
30 patients (0.5%) had neurologic feature (pain, paresthesia, weakness, motor deficit); 3/30 patients had block-related injury (0.4 per 1000 blocks; 95% CI 0.08 to 1:1000).
Eleven of the 30 patients received lower extremity nerve blocks; seven were unrelated to the block; one due to tourniquet neuropraxia; one had an underlying neuropathy; two related to block (sensory deficits lasted 12 months and greater than 6 months, respectively).
Orebaugh et al (2012)270 Retrospective study using Quality Improvement electronic database3543 (39%) of 9069 blocks were for the lower extremity.
Four patients displayed symptoms lasting 6–12 months while one lasted more than 12 months.
The type of nerve block where injury occurred not specified.
Hajek et al (2012)287 Retrospective study of neuropathic complications after continuous popliteal nerve blocks157 blocks.
Three patients displayed common peroneal nerve damage (surgical causes eliminated).
One patient—motor function improved at 5 months but had residual weakness; two patients—improved motor but residual hypoesthesia at 11 months.
  • PNS, peripheral nerve stimulation.