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LETTERS TO THE EDITOR

How Can We Possibly Prevent Complications Related to Peripheral Nerve Blocks?

Department of Anesthesiology, The University of Texas Medical School at Houston, Houston, Texas

To The Editor:

I read with interest the case report presented by Dr. Vaisman (1) and would like to take the opportunity to make the following comments.

First, it is very frustrating to read a case report with a reference that cannot be found in a major medical center library. I am referring to Reference 2, Moore DC, Block of the inguinal region. If I cannot find the referenced book in the Texas Medical Center Library in Houston, I am wondering what the chances are that an anesthesiologist practicing outside a large metropolitan center can find it. Also, Reference 4 (Johr M, Sossai R. Colonic puncture during ilioinguinal nerve block in a child) should read Anesth Analg 1999;88:1051–2 rather than 1999;78:314–6.

Second, I am somewhat surprised that to do a fascia block, the author used a 22-gauge spinal needle, which is a sharp needle. Not only might the use of such a needle increase the risk of vascular puncture, but it is also noteworthy from a technical standpoint that with a sharp needle, it is more difficult to feel the passage through the fascia. The use of a blunt needle seems more appropriate. In this regard, there are several alternatives, such as a Tuohy needle (if the author is particular about a 22-gauge, B. Braun Medical distributes such a needle) or the use of a blunt needle (Arrow International makes an 18-gauge single or continuous brachial plexus set). Although it is unrealistic to believe that all complications associated with the use of peripheral nerve blocks can be prevented, we need to differentiate between complications such as those reported recently by Horlocker et al. (2) that are an intrinsic risk of performing peripheral nerve blocks and the preventable ones. In contrast, there are complications that frequently can be, at least, reduced, such as the cases presented by Drs. Benumof and Vaisman (1,3).

It is unfortunate that in most textbooks little consideration is given to the most appropriate type of needle and/or the size. All needles are not created equal for a given block.

In conclusion, no one is immune from complications when performing peripheral nerve blocks and the author should be commended for reporting his experience. However, some consideration should be given to being more discriminative about the type of needle that we use, especially if it might help reduce and/or prevent a complication.

References

1. Vaisman J. Pelvic hematoma after an ilioinguinal nerve block for orchialgia. Anesth Analg 2001; 92: 1048–9.[Free Full Text]
2. Horlocker TT, O’Driscoll SW, Dinapoli RP. Recurring brachial plexus neuropathy in a diabetic patient after shoulder surgery and continuous interscalene block. Anesth Analg 2000; 91: 688–90.[Abstract/Free Full Text]
3. Benumof JL. Permanent loss of cervical spinal cord function associated with interscalene block performed under general anesthesia. Anesthesiology 2000; 93: 1541–4.[Web of Science][Medline]

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a colleague Similar articles in this journal Similar articles in Web of Science Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via Web of Science (3) Citing Articles via Google Scholar Google Scholar Articles by Chelly, J. E. Search for Related Content PubMed PubMed Citation Articles by Chelly, J. E.