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KEY POINTS

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KEY POINTS

  1. Safe regional anesthesia begins with thorough knowledge of anatomy. In Labat’s words, “anatomy is the foundation upon which the entire concept of regional anesthesia is built.” Studying the anatomy of the major plexuses and peripheral nerves is critical for learning regional anesthesia and avoiding complications.

  2. Prior to performing regional anesthesia, it is imperative to discuss thoroughly the techniques and their limitations with the patient. Assessing which patients are most appropriate for performing these techniques on is important, as some are not suitable candidates (eg, those with major anatomic distortion or serious mental illness).

  3. One of the most important principles for safe regional anesthesia is provision of a comfortable patient environment. If a patient suffers as a result of one’s intervention, a basic principle of anesthesia practice has been violated.

  4. Resuscitation equipment must be immediately available when performing regional anesthesia. One must be prepared at all times to anesthetize and resuscitate the patient if necessary.

  5. A skilled anesthesia provider must be willing to abort the technique in the face of failure. Dogged persistence is inadvisable. One must seek assistance when faced with difficulties and be prepared to adopt an alternative route of anesthesia if persistent failure (more than three attempts or 20 minutes) occurs.

  6. Do not perform regional anesthesia procedures in anesthetized adult patients unless the benefits far outweigh the risks. If this principle is violated, the reasoning must be documented in the patient’s file.

  7. Always be accompanied by a skilled assistant when performing regional anesthesia.

  8. The patient must be monitored adequately at all stages during regional anesthesia. Close monitoring can only be discontinued when the block has worn off completely.

  9. If neurologic injury following regional anesthesia is suspected, the cause should be determined quickly to prevent permanent injury. Timely advice should be sought from appropriate consultants (neurologists, radiologists).

  10. One must not assume that all patient injury is from regional anesthesia, as other possibilities exist. Do not hesitate to involve other disciplines in the quest to determine the cause of injury.

  11. A major consideration for the pediatric population is that regional anesthesia is typically performed with the patient under anesthesia or heavy sedation due to children’s generally uncooperative nature. This has implications ranging from patient consent to recognizing complications.

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INTRODUCTION

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Adverse events have been associated with regional anesthesia since local anesthetics were first introduced in 1884 by Koller.1 No matter how skillful an anesthesia provider may be, adverse perioperative events are inevitable in anesthesia practice. Instead of addressing all potential complications of regional anesthesia, we focus here on those most relevant to current adult practice and most of the pertinent considerations for managing complications in the pediatric population.2

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GENERAL PRINCIPLES

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IMPORTANCE OF PREVENTION

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The time-honored statement that “an ounce of prevention is worth a pound of cure” is essential3 when considering the management of adverse outcomes in regional anesthesia ...

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