Nerve Injury

[militarymd]

For those of you who do regional anesthesia.

What do you do with patients who complain about persistent paresthesia/paresis after a peripheral nerve block?
1) after 1 week
2) after 8 weeks

What do you tell them?

How do you manage them?

Who do you consult?

Have you seen one?

I'm doing more and more blocks lately....as my practice is getting more and more busy, especially with the insured ASA I with sports related injuries, etc.

As I'm doing more and more of these blocks, I'm starting to think more about some of these injuries and what you do with them.

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[militarymd]

No replys?

 

[Lizard1]

although we could use our knowlege to proceed with a workup of the pathogenesis/treatment - why not refer to a specialist, a neurologist. I hate to pass the buck, especially if it most likely your fault, but your testimony in court as to an unsuccessful or delayed treatment referral will not hold a candle to neurologist. How many times do neurologists refer epidural blood patches to us after a PDPH even though they are quite capable of performiing them themselves?

I say utilize your resources and refer to the neurologist

 

[Bubblehead-to-MD]

militarymd,

Is this how a GOOD civilian physician finds solutions to his clinical problems??? Were you unable to locate a respected medical reference to obtain some evaluated guidelines with regard to this specific case? Hmmmmhhh...how would the patient feel about your reference being a post from a fellow SDNer with unknown experience?

Cheers.

 

[militarymd]

militarymd,

Is this how a GOOD civilian physician finds solutions to his clinical problems??? Were you unable to locate a respected medical reference to obtain some evaluated guidelines with regard to this specific case? Hmmmmhhh...how would the patient feel about your reference being a post from a fellow SDNer with unknown experience?

Cheers.

Yes, a good civilian physician uses all resources available to him...including anonymous forums where people I respect from across the country (and maybe even the world) contribute to the knowledge in medicine.

Nerve Injury as a result of regional anesthesia is an area that is not well studied....most anesthesiologists are not familiar with it.....do a pubmed search yourself if you 're not convinced.

I would recommend you do a little of the same with your speciality...find out if 3 hour TAHs with 3 liter blood loss are really acceptable.

 

[militarymd]

militarymd,

Is this how a GOOD civilian physician finds solutions to his clinical problems??? Were you unable to locate a respected medical reference to obtain some evaluated guidelines with regard to this specific case? Hmmmmhhh...how would the patient feel about your reference being a post from a fellow SDNer with unknown experience?

Cheers.

oh...and read the original post....it is a rhetorical question....I have not had ANY nerve injuries.

 

[Noyac]

Most peripheral nerve injuries from regional anesthesia reslove on their own without any intervention . The longest I may have heard of was 6 weeks but I really don't recall since they are sooooo rare. I have never had one and I do a ****e load of regional. I have never seen one and I don't recall any partners having one.

With that being said. If I had one that I was really concerned about, I would start them on physical therapy, neurontin, and a TCA. I would reassure them that the symptoms would resolve, as most all of them do. I believe the nreve injuries are becoming more and more obsolite since the advent of nerve stimulators and US, as opposed to paresthesia techniques.

 

[militarymd]

Most peripheral nerve injuries from regional anesthesia reslove on their own without any intervention . The longest I may have heard of was 6 weeks but I really don't recall since they are sooooo rare. I have never had one and I do a ****e load of regional. I have never seen one and I don't recall any partners having one.

With that being said. If I had one that I was really concerned about, I would start them on physical therapy, neurontin, and a TCA. I would reassure them that the symptoms would resolve, as most all of them do. I believe the nreve injuries are becoming more and more obsolite since the advent of nerve stimulators and US, as opposed to paresthesia techniques.

True, but looking at the latest ASA Closed Claims Project, nerve injury claims are going up...I think...but they do include injuries from other than nerve blocks.

 

[Noyac]

True, but looking at the latest ASA Closed Claims Project, nerve injury claims are going up...I think...but they do include injuries from other than nerve blocks.

While I haven't looked at the claims specifically, It is my understanding that those nerve injury claims are mostly from positioning. The typical anesthesiologist today performs more regional anesthetics than in the past. This increase in numbers of regionals performed has possibly increased the number of claims.

 

[jetproppilot]

For those of you who do regional anesthesia.

What do you do with patients who complain about persistent paresthesia/paresis after a peripheral nerve block?
1) after 1 week
2) after 8 weeks

What do you tell them?

How do you manage them?

Who do you consult?

Have you seen one?

I'm doing more and more blocks lately....as my practice is getting more and more busy, especially with the insured ASA I with sports related injuries, etc.

As I'm doing more and more of these blocks, I'm starting to think more about some of these injuries and what you do with them.

I'm apologetic, Mil.

Have been in Florida cruising Tampa Bay in a thirty-foot Contender.

Heres my contribution:

Did an axillary block on a dude for a carpal tunnel. It was a piece-of-cake block that took just a cuppla minutes.

Carpal tunnel went fine.

Post-op Dude had residual numbness in his hand.

Unknown whether it eas surgical or anesthetic-related.

I assured the dude that the likelihood was it would go away.

Gave him my cell phone number and told him to call me in 2 weeks.

He called me. Still with residual hand numbness after two weeks.

To make a long story short, all his symptoms resolved after 8 weeks.

I saw him twice in the interum. And examined him.

Hoping his symptoms would resolve.

They did.