Regional Anesthesia / Monitored Anesthesia Care

This study used the ASA Closed Claims Program database to assess patterns of injury and liability associated with operating room (OR) fires. Files from 1985 to 2009 were reviewed for this study. OR fires were an increasing source of injury to patients and liability for anesthesiologists. Electrocautery procedures in the presence of supplemental oxygen, especially by open delivery systems, during MAC were predominant mechanisms for OR fires. Continuing education and communication along with fire prevention protocols are crucial components to reducing the occurrence of OR fires.

Peripheral nerve block claims from 1990 or later in the acute pain and surgical setting were analyzed. Neuraxial blocks, eye blocks, and chronic pain blocks were excluded. Among 189 peripheral nerve block claims, the most common blocks were interscalene, axillary and intravenous regional anesthesia. There were no claims associated with newer techniques such as ultrasounded guided blocks, TAP/rectus sheath, or paravertebral blocks. There was one lumbar plexus/sciatic block and two claims associated with ilioinguinal blocks. Most peripheral nerve block claims were associated with temporary or non-disabling injuries. The most common complications were nerve injury (51%), death (11%), pneumothorax (6%), and brain damage (5%).

Anesthesiologists who provided both the eye block and sedation for eye surgery (n = 59) had more injuries associated with block placement, a higher proportion of claims with permanent injury, and a higher proportion of claims with plaintiff payment, compared with anesthesiologists who provided sedation only (n = 38). Peripheral nerve blocks (n = 159) were primarily associated with temporary injuries (56%). Local anesthetic toxicity was associated with 7 of 19 claims with death or brain damage. Performance of eye blocks by anesthesiologists significantly alters their liability profile, primarily related to permanent eye damage from block needle trauma. Though most peripheral nerve block claims are associated with temporary injuries, local anesthetic toxicity is a major cause of death or brain damage in these claims.

Almost half of the regional anesthesia claims in the Closed Claims database from the 1980s and 1990s were block related, but the majority of obstetric claims are associated with temporary or low severity injury. Neuraxial cardiac arrest accounts for one third of high-severity injuries for obstetric and nonobstetric procedures, whereas neuraxial hematomas associated with coagulopathy result predominately from nonobstetric claims. Eye blocks have emerged as a new source of permanent injury in the 1990s.