Preprocedural checklist for regional anesthesia: impact on the incidence of wrong site nerve blockade (an 8-year perspective)

Abstract

BackgroundThe term “Wrong-Site Surgery (WSS)” is commonly associated with surgical procedures; however, The Joint Commission (TJC) considers any invasive procedure, not just a surgical procedure, performed on the wrong side, at the wrong site, or on the wrong patient to be a WSS. For anesthesia providers, this means that a wrong-site nerve block (WSNB) also constitutes a WSS and would be considered a sentinel event by TJC. In an attempt to combat WSNB, the American Society of Regional Anesthesia and Pain Medicine published guidelines in 2014 recommending the use of a preprocedural checklist before performing regional blocks. The effectiveness of such a checklist, however, to reduce the occurrence of WSNB has not yet been demonstrated. We hypothesized that the introduction of a preprocedural checklist specific for regional anesthesia would be associated with a lower rate of WSNB procedures.MethodsA retrospective review was performed to compare the incidence of WSNB 2 years before, to 6 years after the implementation of a preprocedural checklist specific to regional anesthesia.ResultsPrior to checklist implementation, 4 WSNB events occurred during 10 123 procedures (3.95 per 10 000 (95% CI 1.26 to 9.53). Following implementation, WSNB events occurred during 35 890 procedures (0 per 10 000 (95% CI 0 to 0.84)); p=0.0023.ConclusionsImplementation of a regional anesthesia specific preprocedural checklist was associated with a significantly lower incidence of WSNB procedures. While prospective controlled studies would be required to demonstrate causation, this study suggests that for regional anesthesia procedures, a preprocedural checklist may positively impact patient safety.

Control Exitoso del dolor oncológico crónico por cáncer de pulmón con el bloqueo del plano del erector espinal (BPEE) en un servicio de neumología. Reporte de caso

“…El BPEE posee una mayor penetración a tejidos nerviosos como el espacio peridural, lo que conlleva un riesgo de complicaciones-Aunque el BPEE ha sido encontrado más seguro que el bloqueo paravertebral o el epidural torácico, se necesitan grandes ensayos clínicos donde se evidencie la seguridad y la frecuencia de complicaciones de este procedimiento [9]- [11]. El procedimiento debería realizarse con una monitorización básica, para facilitar la administración consuetudinaria de este bloqueo en pacientes oncológicos, todo esto en un proceso de estandarización de su uso; se debería realizar una lista de verificación para mejorar la seguridad del procedimiento [13].…”

Error traps in pediatric regional anesthesia

“…The American Society of Regional Anesthesia and Pain Medicine’s recommended checklist includes four elements (Figure 1). 3 Although the implementation of this checklist was associated with a significantly lower incidence of wrong‐site nerve block procedures, it lacks a specific correct block site confirmation 4 . More recently, a checklist for pediatric regional anesthetics incorporated laterality in its design with the goal of preemptively mitigating factors that could lead to wrong‐side/site nerve blocks while also minimizing the potential for identifying inappropriate use of blocks based on the patient’s medical history 5 …”

Двадцать Лет «серебряной Пули» Против Интоксикации Местными Анестетиками

“…Деякі установи застосовують передопераційні чек-листи з нагадуванням, що слід перевірити. Такі чек-листи сприяють зменшенню числа ускладнень [44,45]. Основні принципи запобігання ІМА наведені нижче.…”