Peripheral Nerve Injuries from Regional Anesthesia: A Narrative Review



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Abstract

Peripheral nerve injury is defined as a condition determined at least 48 hours after regional blockade in the form of sensory and/or motor disturbances in the area of innervation of the affected nerve, confirmed by the results of neurological examination. The incidence of transient neuropathies associated with peripheral nerve blockade is 2.2%, with permanent neurologic deficits ranging from 2 to 4 per 10,000 blockades. Although postoperative nerve injury is rare, when such complications do occur, they present significant problems for both the patient and the anesthesiologist. The aim of the work was to summarize the data presented in modern scientific literature on the prevention and treatment of peripheral nerve injuries during regional anesthesia. We searched for publications for the period from 2014 to 2024 by keywords in Russian and English: peripheral nerve, injuries, regional anesthesia, neurological complications, prevention of nerve injuries in PubMed, Elibrary, and CyberLeninka. The search revealed 383 publications, of which 433 were excluded because they described peripheral nerve injuries no associated with regional anesthesia. The remaining 50 publications formed the basis of this review. The review presents the anatomy of peripheral nerves, classification of their injuries, details mechanical, intraneural, ischemic and neurotoxic mechanisms of nerve injury. Methods of prevention of nerve injuries are outlined. It is shown that the combined use of neurostimulation, which helps to identify the nerves, ultrasound navigation, which helps to visualize the nerve, pressure monitor during injection, which helps to avoid nerve injury, are the key to safe regional anesthesia. The diagnosis of nerve injuries is described, which includes, in addition to the clinical signs, computed tomography and electrophysiologic examinations. The algorithm of observation of a patient with suspected nerve injury after regional anesthesia is given. The methods of treatment of peripheral nerve injury, including physiotherapy, drug treatment, low-frequency electrical stimulation, low-intensity ultrasound, and phototherapy, are described in detail. Peripheral nerve injuries during regional blockade is rare and is more often neuropraxic in nature, hence transient and has a favorable prognosis. The combined use of neurostimulation, ultrasound navigation and pressure monitoring during injection are the key to successful and safe regional blockade. Treatment of nerve injuries requires a multidisciplinary. The development of national recommendations for the prevention of nerve injuries during regional blockade will help anesthesiologists to reduce the risk of complications.

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About the authors

Viktor A. Koriachkin

Saint Petersburg State Pediatric Medical University, Saint Petersburg, Russia; Turner National Medical Research Center for Сhildren’s Orthopedics and Trauma Surgery, Saint Petersburg, Russia

Email: vakoryachkin@mail.ru
ORCID iD: 0000-0002-3400-8989
SPIN-code: 6101-0578
Scopus Author ID: 0000-0002-3400-8989

MD, Dr. Sci. (Medicine), Professor, Professor of the Department of Anesthesiology, Resuscitation and Emergency Pediatrics n.a. prof. V.I. Gordeeva

Russian Federation, Saint Petersburg, Russia; Saint Petersburg, Russia

Dmitrii V. Zabolotskii

Saint Petersburg State Pediatric Medical University, Saint Petersburg, Russia; Turner National Medical Research Center for Сhildren’s Orthopedics and Trauma Surgery, Saint Petersburg, Russia

Email: zdv4330303@gmail.com
ORCID iD: 0000-0002-6127-0798
SPIN-code: 6726-2571

MD, Dr. Sci. (Medicine), Professor

Russian Federation, Saint Petersburg, Russia; Saint Petersburg, Russia

Vladimir A. Evgrafov

Saint Petersburg State Pediatric Medical University, Saint Petersburg, Russia

Author for correspondence.
Email: evgrafov-spb@mail.ru
ORCID iD: 0000-0001-6545-2065
SPIN-code: 6322-3961

MD, Cand. Sci. (Med.), Assistant Professor

Russian Federation, Saint Petersburg, Russia

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