OTHER NERVE BLOCKS

PROBLEMS

Arrhythmias (1)
Signs of intravascular injection of local anaesthetic (2)
Equipment malfunction with the use of tourniquets (3)
Pneumothorax with blocks near the thoracic cage (4)
With patient and operative site identification (5)

EMERGENCY MANAGEMENT

Reassure the patient and sedate if appropriate
Inform the surgeon
Stop the procedure, especially for vagal responses
For tourniquet failure, reinflate and prepare to treat for intravascular injection of LA
If intravascular injection is suspected
     Stop injection of local anaesthetic
     Administer 100% oxygen
     Prepare to support airway, breathing and circulation
     Prepare anticonvulsant, (thiopentone/midazolam) and give if fitting does not resolve within 15 seconds
     Do not hesitate to treat as cardiac arrest
     If bradycardic consider atropine 0.6mg
If pneumothorax is suspected, go to pneumothorax
If intra-arterial injection of adrenaline containing LA is suspected, observe closely for local ischaemia.
     Consider a vasodilator.
For block failure, convert to a general anaesthetic
                           or use supplementary local infiltration (beware of overdosage).

FURTHER CARE

Confirm and correct cause
Review patient in the ward to assess delayed events (6), (7)
Counsel the patient and explain what happened

NOTES:
Ý Top

The figures reported here are based on an analysis of 56 of the first 4000 AIMS anaesthesia incidents (22% of 252 regional anaesthesia incidents), and which included blocks such as:
- ophthalmic blocks 9%
- brachial plexus blocks 8%
- local nerve blocks 3%
- Bier's blocks 2%

(1) Bradycardia reported in 5 reports of ophthalmic blocks that all resolved spontaneously (see (7) below)
(2) Intravascular injection of local anaesthetic reported in 8% of all regional anaesthesia incidents, with symptoms from
     dizziness to seizures reported.
(3) 4 reports of tourniquet failure in Bier's blocks; beware the assistant who may inadvertently deflate tourniquet.
(4) 3 reports, 1 confirmed pneumothorax, 2 suspected from patient clinical signs of chest pain, and not requiring drains.
(5) 4 reports of the incorrect side blocked. In 2 of these reports the patients identified the incorrect side as the site for operation. 1 report of an epidural inserted in the wrong patient. In all but one case the consent form was correct.
(6) Intravascular instead of interneural injection in 13 ophthalmic blocks
(7) Corneal abrasion reported after cataract surgery under peribulbar block from inappropriate use of mercury weight;
      pneumothorax reported after a supraclavicular block.