A Retrospective Review of 4767 Consecutive Spinal Anesthetics

Horlocker, Terese T.; McGregor, Diana G.; Matsushige, Derek K.; Schroeder, Darrell R.; Besse, Jennifer A.

doi:10.1097/00132586-199712000-00053

Cited by 23 publications

(34 citation statements)

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“…In a recent large retrospective study, Horlocker reported similar findings. 10 Pain on injection resulted in one patient with permanent foot drop and in another with persistent pain in a toe for almost one year in our claims. The anesthesiologist who performs neuraxial block should be cognizant of the signs of needle trauma.…”

Section: Neuraxial Blocksmentioning

confidence: 61%

“…This complication rate remains low, ranging from 0.04% to 0.11%, judging from the studies published in the last few years. 8,10 In our series, 22 claims (34%) were due to neurological injury, with 19 cases following neuraxial block. An unfavourable outcome occurred in three cases, all suffering paraplegia following neuraxial blocks, reflecting the severe nature of this complication.…”

Section: Neuraxial Blocksmentioning

confidence: 66%

“…[4][5][6] Complications resulting from various regional techniques have been well described. [7][8][9][10][11] Complications can result in patient suffering, malpractice claims and economic hardships. Studies of insurance claims related to anesthesia practice in the USA and Finland have been published.…”

Section: Reports Of Investigationmentioning

confidence: 99%

“…[18][19][20] Over the years, this safety record of spinal anesthesia has not changed, with reported incidences of 0.08% to 0.12% according to three recent large studies involving more than 50,000 patients. 8,10,11 Similarly, neurological complications following epidural anesthesia, as reviewed by Dawkins three decades ago, are uncommon. 21 In that series, of 32,718 cases, transient paralysis was reported in 48 cases (0.1%), whereas seven patients suffered permanent paralysis (0.02%).…”

Section: Neuraxial Blocksmentioning

confidence: 99%

“…Several risk factors have been described in various studies in association with neurological complications following regional anesthesia, including paresthesia during needle placement or pain during injection of local anesthetic, hypotension, anticoagulation, use of lidocaine, 8,10,11 preexisting neurological condition and arteriosclerosis. 21 In our claims, a similar pattern of risk factors was found (Table X).…”

Section: Neuraxial Blocksmentioning

confidence: 99%

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Litigation in Canada against anesthesiologists practicing regional anesthesia. A review of closed claims

Peng

Smedstad

2000

Can J Anesth/J Can Anesth

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Purpose: To review the pattern of malpractice litigation related to regional anesthesia in Canada. Source: The Canadian Medical Protective Association (CMPA) provided with information about all anesthesia claims that closed in the years 1990-1997.Principal Findings: In the period 1990-97 there were 7,909 closed legal actions involving all CMPA members (56,000). Of these, there were 310 cases involving anesthesiologists, of which 61 cases (approximately 20%) were related to regional anesthesia. Forty-two involved neuraxial blocks, and the legal outcome was favourable (dismissed or judgement in favour of the defendant doctor) in 37 claims. Nineteen claims involved peripheral nerve blocks. All these had favourable legal outcomes. Overall, 10% of regional anesthesia claims have unfavourable outcomes, compared with 28% of all anesthesia related claims and 30% of all CMPA members' claims. The degree of disability in the regional anesthesia claims were: none 10%; minor 49%; major 36%; catastrophic 5%. There were no deaths in the malpractice claims involving regional anesthesia, compared with 17% in the all anesthesia group and 11% in all members' claims. Conclusion:Twenty percent of all anesthesia claims in Canada are related to regional anesthesia. The legal outcome of these claims is favourable in 90%. Unfavourable clinical outcome is associated with catastrophic or major injury. There were no deaths in the regional anesthesia claims.Objectif : Revoir les accusations pour faute professionnelle concernant l'anesthésie régionale au Canada. Source : L'Association canadienne de protection médicale (ACPM) a fourni les renseignements au sujet de toutes les réclamations réglées de 1990 à 1997 qui concernaient l'anesthésie.Constatations principales : De 1990 à 1997 il y a eu 7 909 poursuites judiciaires réglées qui impliquaient des membres de l'ACPM (56 000). De ce nombre, 61 cas étaient liés à l'anesthésie régionale, donc environ 20 % des 310 cas touchant des anesthésiologistes. Dans 42 cas, il s'agissait de blocs neuraxiaux et l'issue de la poursuite a été favorable (action rejetée ou jugement en faveur du médecin accusé) dans 37 cas. Dans 19 cas, c'était des blocs nerveux périphériques. Toutes ces poursuites ont été favorables aux médecins. Globalement, 10 % des réclamations liées à l'anesthésie régionale ont été défavorables contre 28 % de toutes les réclamations anesthésiques et 30 % de celles des membres de l'ACPM. Le degré d'invalidité concernant l'anesthésie régionale ont été : aucun, 10 %; mineur, 49 %; majeur, 36 %; catastrophique, 5 %. Aucun décès n'est lié aux poursuites pour faute professionnelle dans des cas d'anesthésie régionale, à comparer à 17 % dans tous les groupes d'anesthésie et 11 % des réclamations parmi tous les membres. Conclusion :De toutes les réclamations concernant l'anesthésie au Canada, 20 % sont reliées à l'anesthésie régionale. L'issue de ces poursuites est favorable aux médecins dans 90 % des cas. Des résultats cliniques défa-vorables sont liés à des lésions catastrophiques ou majeures. Auc...

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Section: Neuraxial Blocksmentioning

confidence: 61%

Section: Neuraxial Blocksmentioning

confidence: 66%

Section: Reports Of Investigationmentioning

confidence: 99%

Section: Neuraxial Blocksmentioning

confidence: 99%

Section: Neuraxial Blocksmentioning

confidence: 99%

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Litigation in Canada against anesthesiologists practicing regional anesthesia. A review of closed claims

Peng

Smedstad

2000

Can J Anesth/J Can Anesth

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Needle path planning in semiautonomous and teleoperated robot‐assisted epidural anaesthesia procedure: A proof of concept

Haro-Mendoza

Pérez-Escamirosa

Diego³

et al. 2022

Robotics Computer Surgery

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Background Epidural anaesthesia is a Percutaneous Procedure (PP) which plays a crucial role in surgical procedures, where accurate needle insertion is still challenging. The objective of this work is to present a Tuohy needle path planning, which allows an anaesthesiologist to drive semiautonomously, with the assistance of a teleoperated robot, the tip of the needle during this PP. Methods We capture, analysed and modelled the anaesthetist hands' motion during the execution of this procedure, by synthetising, programing and simulating a parametrised and normalised kinematic constrains dependent on an insertion variable in a virtual robot. Results Two preoperative path planning models were obtained, which provide a teleoperated robot with kinematic constraints to semiautonomously drive a Tuohy needle in the epidural anaesthesia procedure. Conclusions A semiautonomous robot can assist in the execution of this PP using the kinematic constraints obtained from the study of the movement of a specialist's hands.

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Differentialindikation zentraler und peripherer Leitungsanästhesien

2000

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Serious neurological complications caused by spinal hematoma or abscess following central neuraxial block have been reported more often during the last years. In contrast, severe complications are extremely rare associated with peripheral nerve blocks. Concerned about the safety of spinal and epidural anesthesia, we encourage the use of peripheral regional techniques for procedures on the lower extremity and especially for postoperative regional analgesia. Motor block due to lumbar epidural anaesthesia using high concentrations of local anesthetic makes spinal hematoma or abscess difficult to recognize. Therefore, low concentrations of local anesthetic should be used for postoperative epidural analgesia. Any increase in motor block following neuraxial blockade should raise the suspicion of a spinal compression (e.g. hematoma or abscess). Other symptoms are back pain, radicular pain or paresthesia and incontinence. Disastrous neurological injuries can only be prevented by immediate diagnosis (MR, CT or myelography) and therapy (surgical decompression).

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A Retrospective Review of 4767 Consecutive Spinal Anesthetics

Cited by 23 publications

References 0 publications

Litigation in Canada against anesthesiologists practicing regional anesthesia. A review of closed claims

Litigation in Canada against anesthesiologists practicing regional anesthesia. A review of closed claims

Needle path planning in semiautonomous and teleoperated robot‐assisted epidural anaesthesia procedure: A proof of concept

Differentialindikation zentraler und peripherer Leitungsanästhesien

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