PPMRRG Blog

Regional Blocks placed during General Anesthesia

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Nerve Damage from Regional Blocks Placed In Anesthetized/Sedated Patients

Whether regional blocks should be placed in adult anesthetized/sedated patients is still being debated within the anesthesiology community.  The debate stems from the fact there is no current peer-reviewed, evidence-based medical literature concluding this technique increases the risk of nerve injury.  However, from the vantage point of defending more than 4,000 lawsuits over the past 23 years, Preferred Physicians Medical (PPM) continues to strongly recommend against using this technique, based on the difficulty of defending injuries resulting when regional blocks are placed while the patient is either anesthetized or sedated. 

Issues That Could Occur

One obvious problem with placing regional blocks in anesthetized/sedated patients is the patient is unable to respond to the pain associated with needle or catheter-induced paresthesias or intraneural injections.  Perhaps the advent and increased use of nerve stimulator needles and ultrasound to assist needle placement may have increased anesthesiologists' comfort level in placing blocks without reliance on physiologic responses.  Nevertheless, there is credible medical literature criticizing the placement of regional blocks in anesthetized patients as inappropriately risky in most cases.  This literature has become an important tool for plaintiff attorneys in recovering substantial settlements and is a challenging obstacle in defending anesthesiologists using this technique.  There are also numerous well-credentialed anesthesiology experts who will readily testify in court this technique is ill-advised and below the standard of care. 

Adding to the challenge, the most common reasons cited by anesthesiologists using this technique are:

• medical convenience, and
• patient comfort 

While these may appear to be legitimate reasons to consider using this technique, the anesthesiologist must weigh and balance the increased risk of nerve injury with those rather modest benefits.  PPM's considerable experience in defending these claims suggests that medical convenience or patient comfort will rarely provide a compelling justification, especially when defending catastrophic nerve damage litigation. 

To read about case summaries highlighting the devastating injuries that can occur when placing regional blocks in anesthetized/sedated patients....