Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2012 Nov-Dec;37(6):577-82.
doi: 10.1097/AAP.0b013e318263d396.

Adverse outcomes associated with nerve stimulator-guided and ultrasound-guided peripheral nerve blocks by supervised trainees: update of a single-site database

Steven L Orebaugh  1 , Michael L Kentor, Brian A Williams
Affiliations

Adverse outcomes associated with nerve stimulator-guided and ultrasound-guided peripheral nerve blocks by supervised trainees: update of a single-site database

Steven L Orebaugh et al. Reg Anesth Pain Med. 2012 Nov-Dec.

Abstract

Background: We previously published a retrospective review of complications related to peripheral nerve blocks performed by supervised trainees, from our quality assurance and billing data, guided by either ultrasound, with nerve stimulator confirmation, or landmark-based nerve stimulator techniques. This report updates our results, for the period from May 2008 through December 2011, representing ongoing transition to near-complete combined ultrasound/nerve stimulator guidance in a block-oriented, outpatient orthopedic anesthesia practice.

Methods: We queried our deidentified departmental quality improvement electronic database for adverse outcomes associated with peripheral nerve blocks. Billing records were also deidentified and used to provide the denominator of total number of blocks using each technique of neurolocation. The types of blocks considered in this analysis were interscalene, axillary, femoral, sciatic, and popliteal-sciatic blocks. Nerve block complications based on each type of guidance were then compared for the entire recent 30-month time period, as well as for the 6-year period of this report.

Results: There were 9062 blocks performed by ultrasound/nerve stimulator, and 5436 by nerve stimulator alone over the entire 72-month period. Nerve injuries lasting longer than 1 year were rare, but similar in frequency with both nerve guidance techniques. The incidence of local anesthetic systemic toxicity was found to be higher with landmark-nerve stimulator technique than with use of ultrasound-guided nerve blocks (6/5436 vs 0/9069, P = 0.0061).

Conclusions: We report a large series of combined ultrasound/nerve stimulator nerve blocks by supervised trainees without major local anesthetic systemic toxicity. While lacking the compelling evidence of randomized controlled trials, this observational database nonetheless allows increased confidence in the safety of using combined ultrasound/nerve stimulator in the setting of anesthesiologists-in-training.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Proportion of specified nerve blocks conducted by peripheral nerve stimulation-landmark technique (versus ultrasound–nerve stimulation technique) during the period January 2008–December 2011. “N” denotes occurrence of nerve injury, “S” denotes occurrence of seizure.
See this image and copyright information in PMC

Comment in

References

    1. Sites BD, Chan VW, Neal JM, Weller R, Grau T, Koscielniak-Nielsen ZJ, Ivani G. The American Society of Regional Anesthesia and Pain Medicine Joint Committee recommendations for education and training in ultrasound-guided regional anesthesia. Reg Anesth Pain Med. 2010;35:S74–S80. - PubMed
    1. Sites BD, Spence BC, Gallagher JD, Wiley CW, Bertrand ML, Blike GT. Characterizing novice behavior associated with learning ultrasound-guided peripheral regional anesthesia. Reg Anesth Pain Med. 2007;34:107–115. - PubMed
    1. Orebaugh SL, Williams BA, Kentor ML, Bolland MA, Mosier SK, Nowak TP. Interscalene block using ultrasound guidance: Impact of experience on resident performance. Acta Anaesth Scand. 2009;53:1268–1274. - PubMed
    1. Barrington MJ, Watts SA, Gledhill SR, Thomas RD, Said SA, Snyder GL, Tay VS, Jamrozik K. Preliminary results of the Australasian Regional Anaesthesia Collaboration. Reg Anesth Pain Med. 2009;34:534–541. - PubMed
    1. Abrahams MS, Aziz MF, Fu RF, Horn J-L. Ultrasound-guidance compared with electrical neurostimulation for peripheral nerve block: A systematic review and meta-analysis of randomized controlled trials. Br J Anaesth. 2009;102:408–417. - PubMed

Publication types