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James Andrews clinic lawsuit
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WOW.
Does Alabama have tort reform?
Does Alabama have tort reform?
Crazy story. Who knows what happened. I assume block for ACL but those guys were strong proponents of saphenous blocks.
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I asked one of our regional anesthesiologists this question before;
would you ever do a nerve block on a professional sports player?
he said yes, no problem
after reading this, i wonder if he would still say the same thing
would you ever do a nerve block on a professional sports player?
he said yes, no problem
after reading this, i wonder if he would still say the same thing
In residency we took care of some minor league baseball players at one of our surgery centers. For knees absolutely no femoral blocks but AC were allowed. And we def did ISB for shoulders.
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deleted87051
The injection was sept 2016
Send to
Arthroscopy. 2017 May;33(5):1082-1091.e1. doi: 10.1016/j.arthro.2017.01.034. Epub 2017 Mar 28.
The Effect of Femoral Nerve Block on Quadriceps Strength in Anterior Cruciate Ligament Reconstruction: A Systematic Review.
Swank KR1, DiBartola AC1, Everhart JS2, Kaeding CC3, Magnussen RA3, Flanigan DC4.
Author information
Abstract
PURPOSE:
To assess the isokinetic, functional, and patient-reported outcomes of femoral nerve block (FNB) compared with traditional multimodal anesthesia for FNB in anterior cruciate ligament (ACL) reconstruction.
METHODS:
A systematic search of PubMed, Scopus, Cumulative Index to Nursing and Allied Health Literature, Cochrane Reviews, and Google Scholar was conducted according to the 2009 Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Effects of FNB on quadriceps function were evaluated by isokinetic testing, functional scoring systems, range of motion, and patient self-report questionnaires. Heterogeneous reporting of outcomes precluded a formal meta-analysis. The methodologic merit of all studies included was evaluated by the Coleman Methodology Score.
RESULTS:
Six studies were identified with outcome measures reported between 7 days and 6 months postoperatively. At 6 months, 2 of 4 studies that reported isokinetic testing found significantly greater deficits among patients who received a nerve block; one of the remaining studies showed a deficit at 6 weeks but not 6 months. Limited data showed no significant differences in functional or patient-reported outcomes at 6 months after reconstruction, and data regarding the impact of FNB on return to sport were inconclusive. The mean Coleman Methodology Score for the included studies was 53, indicating poor overall methodologic quality of the available literature.
CONCLUSIONS:
The limited data available suggest that FNB causes a measurable deficit in quadriceps isokinetic strength during the early postoperative period but has no effect on functional outcomes or return to sport at 6 months after ACL reconstruction. However, current clinical evidence is not sufficient to draw any valid or definitive conclusions regarding the effect of FNB on postoperative outcomes after ACL reconstruction.
I ALWAYS mention the rare possibility of permanent nerve injury causing pain, weakness , numbness, or all 3.
If that scares the patient I don’t try to talk them into it. I am an active person that values maximum musculoskeletal performance for as long as possible in this life and I personally wouldn’t have any peripheral nerve blocks. I’ve only allowed them for my dental procedures. Other than that, only infiltration.
If that scares the patient I don’t try to talk them into it. I am an active person that values maximum musculoskeletal performance for as long as possible in this life and I personally wouldn’t have any peripheral nerve blocks. I’ve only allowed them for my dental procedures. Other than that, only infiltration.
When I was a resident, one of our attendings did his fellowship at HSS and said they never did any regional on professional athletes.
In my practice I don't take care of professionals, but do care for plenty of D1 athletes and we do use regional on them as with any other patient.
I believe it's in Florida which is one of the worst states around for MedMal.
Haven’t review literature since but I thought there was a concern of long term quad weakness that would only be truly measurable in highly skilled athletes. At least that was our discussion then.
Also I stand corrected, he's prob suing for economic damages... There is no cap for that.
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Floyd was a MONSTER at Florida too.
At our hospital, BMI < 30 counts as being highly skilled athlete!
I’ve never done a block for a knee scope / ACL. Won’t start now!
I wouldn’t do a nerve block on a pro athlete unless they were insistent.
The best block is an lma
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deleted162650
I'd try to avoid blocking a professional athlete just like I'd try to avoid intubating a professional opera singer. I think offering a post-op block (after a very thorough pre-op discussion of risk/benefit) is a reasonable approach so at least they can make a real time informed decision if the pain control is worth the risk. I'd explain that if I were to end up with a 10% deficit, I probably would notice much, but for them it could mean millions of dollars lost.
Part of my standard consent when adding regional to procedures. I've heard attendings say to water down things for people at times but i feel patients are more angry when something happens unless given all the info including some of the scary stuff (majority).
I know you cant cover everything but I've got my chat with everything down pretty quick. I dont think it slows me down on consents either adding those things. If patients are worried it's better to talk about it sooner rather later.
Our hospital still requires separate anesthesia consent done by staff or residents, so I'm all for saving time.
wise words
A huge pain in the ass but they won't be able to prove it was from the nerve block. This guy has a significant knee injury history.
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deleted162650
Even if you can prove the guy has a block related injury, it’s a hard sell that it’s malpractice considering it’s a known risk the patient (hopefully) agreed to in writing.
True, very defensible, but cold comfort for Dr Andrews.
Pretty wild how one bad outcome, whether surgery/anesthesia is guilty or not, can ruin someone’s reputation just like that in the eye of the public, before anybody knows any of the facts. That being said, Dr. Andrews is definitely a high profile physician, so I guess it comes with the territory.
When dealing with people who have careers (opera singers) and millions of dollars (athletes) on the line, why take the risk? It will in all likelihood be settled but heaven forbid it goes in front of a jury and a lawyer says "this thing that didn't really . need to be done cost my client millions of dollars and his entire career". We know the science but they don't. They just see a dude who lost a bunch of money. I would never put someone who is actively involved in their career under that risk.
Let's push this discussion.....would you do Upper extremity nerve blocks for a surgeon or anesthesiologist?
i think if the patient is a surgeon or an anesthesiologist
they would better appreciate the risks and benefits of a block
so... yes i would if they agree to it
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deleted87051
Definitely more to this story than just a nerve block gone wrong. Sucks that it'll damage the reputation of the Andrews center and the anesthesiologists there.
Also for everybody talking about regional for athletes, the Andrews Center does more professional athletes than any center out there. If they're doing blocks for everybody and that's their standard of care then I don't see why this should change that.
Also for everybody talking about regional for athletes, the Andrews Center does more professional athletes than any center out there. If they're doing blocks for everybody and that's their standard of care then I don't see why this should change that.
I know an anesthesiologist who isn’t able to practice anymore from what he says was the nerve block for his shoulder surgery. He teaches at a medical school now. Sad story.
Not on me. Not during my working years.
He should be glad the injury spared him the TBI from a career playing as a NFL lineman. Then again, if he thinks $180M is appropriate maybe he and his lawyer already have TBI.
Many of my colleagues and friends, myself included, have had PNBs. We are all doing just fine thank you. The worst case was 15 years ago when a physician got paresthesias in his fingers for 6 months after an axillary block ( I didn't do the block). It resolved completely. With the use of U/S I would have an expert do a PNB on me without hesitation.
If this is block related (big if, but I would think EMGs could answer that), he did suffer massive economic losses. He was already making 7mm/y and poised to make considerably more on his next deal. That is something that must be reconciled here.
I respect the hell out of you, Blade, and that’s your call. I can take pain but I need my hands to function to do my job and even a 1:1,000 risk is more than I am willing to accept.
His Quad weakness may have been partially due to the FNB. This weakness can persist for more than a year as the combination of surgery and block lead to weakness postop.
FYI, I have performed Adductor Canal and Popliteal blocks for ACL repairs on many outpatients with excellent results.
Adductor Canal Block Provides Noninferior Analgesia and Superior Quadriceps Strength Compared with Femoral Nerve Block in Anterior Cruciate Ligament Reconstruction | Anesthesiology | ASA Publications
In this study they limited the local volume to 15 mls for the adductor canal in order to minimize proximal spread. They also added an IPACK.
https://medcraveonline.com/JACCOA/JACCOA-10-00381.pdf
https://medcraveonline.com/JACCOA/JACCOA-10-00381.pdf
I know right!! Aaron Donald is the best 3 technique lineman in the league and he's only paid $135 mil...
If anything this article will force us to look HARD at our block techniques... I have an attending that does cutting needle out of plane blocks, that attending's patients usually require a ridiculous amount of sedation before the block because the pt literally jumps sometimes during blocks... (one might deduce from direct nerve cutting). I literally do everything I can to not do a block with that attending because i don't want that nerve damage on me. Especially when in plane techniques with US and a 22g needle can be done without any sedation....
Also, a lot of people do the block for the sake of the billing and don't focus on doing the block correctly... hopefully this will make them think more about improving their techniques too.
Sharrif Floyd had an arthroscopic case, not an open ACL repair i believe.
Guy I know finished up at hss fellowship within the past 3-10 years (so not to try to disclose which. Fellows) says it’s surgeon dependent. So some will ask for blocks on athletes
As a naive resident I thought regional anesthesia was great until the day I had to anesthetize a professional athlete and the surgeon requested general anesthesia BECAUSE he was a professional athlete. I came to the conclusion that if it’s not good for professional athletes, it can’t be that great for the general public.
The benefit of a block last for 3 days tops. The downside lasts forever.
Yeah....put me to sleep and give me some Motrin. I have a mortgage and mouthes to feed.
And if Draymond Green comes into my OR, he's going to sleep and getting Motrin too.
And if Draymond Green comes into my OR, he's going to sleep and getting Motrin too.
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Had a big interdepartmental meeting with our Ortho Dept. They love regional and we do a boatload of it for them. When asked not a single one said they would want it if they were working. I wouldn't take one either, risks are extremely small but significant when you work with your hands. If I'm retired and getting my shoulder done then definitely
STOP putting tourniquets around the block site. Every single orthopedic case I take care of I make sure the tourniquet is either above or below the block. Im just betting Mr Andrews had two rooms going fellow in each room. Longer tourniquet times my bet it was not the femoral nerve or the abductor canal, likeky the popliteal sciatic block the resulted in injury. Rescue blocks are also likely to cause nerve injury if you cannot document an intact neuro exam and short tourniquet times less then 1.5hrs.
Evidence?
"downside"? You need someone who knows what they are doing to perform the block. Inject the local NEAR the nerve (or nerves) and not in it using good technique and the risks are less than driving to work each day.
The problem in my mind is human error. Doing a block will always risk a needle pass through a nerve, it can't be 100% prevented. I don't want a needle to pass through my nerves. I can take some pain for a few days. Surgical pain may be intense at first but once it starts to dissipate it goes away fast.
