Incidence and etiology of postoperative neurological symptoms after peripheral nerve block: a retrospective cohort study

Abstract

Background: Nerve injury from peripheral nerve block (PNB) is an uncommon but potentially serious complication. We present a retrospective cohort study to evaluate the incidence and etiology of new postoperative neurological symptoms after surgery and regional anesthesia.

Methods: We performed a retrospective cohort study of all PNBs performed on elective orthopedic and plastic surgical patients over 6 years (2011-2017). We collected patient and surgical data, results of neurophysiological and imaging tests, neurology and chronic pain consultations, etiology and outcome for patients with prolonged neurological symptoms (lasting ≥10 days).

Results: A total of 26 251 PNBs were performed in 19 219 patients during the study period. Transient postoperative neurological symptoms (<10 days) were reported by 14.4% (95% CI 13.1% to 15.7%) of patients who were reached by telephone follow-up. Prolonged postoperative neurological symptoms (≥10 days) were identified and investigated in 20 cases (1:1000, 95% CI 0.6 to 1.6). Of these 20 cases, three (0.2:1000, 95% CI 0.04 to 0.5) were deemed to be block related, seven related to surgical causes, three due to musculoskeletal causes or pain syndromes, one was suspected of having an inflammatory etiology and six remained of undetermined etiology. Of those who completed follow-up, 56% had full recovery of their symptoms with the remaining having partial recovery.

Conclusion: This retrospective review of 19 219 patients receiving PNBs for anesthesia or analgesia suggests that determining the etiology and causative factors of postoperative neurological symptoms is a complex, often challenging process that requires a multidisciplinary approach. We suggest a classification of cases based on the etiology. A most likely cause was identified in 70% of cases. This type of classification system can help broaden the differential diagnosis, help consider non-regional anesthesia and non-surgical causes and may be useful for clinical and research purposes.

Keywords: brachial plexus; lower extremity; nerve injury.