The types and severity of complications associated with interscalene brachial plexus block anesthesia: local and national evidence

Abstract

Interscalene brachial plexus block is a commonly used anesthetic. However, substantial complications can be associated with its use. Our study included 15 years of data from a local medical center and 3 decades of records from the national American Society of Anesthesiology Closed Claims Project. The hospital had 27 peripheral neurologic injuries, 3 central nervous system complications, 6 respiratory complications, and 5 cardiovascular complications. Of these complications, 14 were still present at the most recent follow-up, some causing major compromise of the patient's comfort and function. All central blocks, local toxicities, and respiratory complications resolved. In the hospital series, more experienced anesthesiologists tended to have lower complication rates. The American Society of Anesthesiology Closed Claims database had 20 peripheral neurologic injuries, 10 respiratory complications, 5 central nervous system complications, 4 deaths, 2 emotional disturbances, and 1 other unknown event. Of the complications, 19 were described as permanent. Interscalene brachial plexus block can be accompanied by substantial and disabling complications, especially when administered by less experienced anesthesiologists.