This document discusses complications that can arise from regional anesthesia. It covers nerve injuries, infections, systemic toxicity from local anesthetics, and issues related to anticoagulation. Specific complications covered include nerve injuries from peripheral nerve blocks, infections from continuous perineural catheters, cardiac and neurological toxicity from local anesthetics, and challenges with anticoagulated patients. Prevention strategies and management approaches are provided.

1. Complications of Regional Anesthesia Nabil M Elkassabany MD MSCE Assistant Professor Director; Orthopedic Anesthesia Section Department of Anesthesiology and Critical Care University of Pennsylvania Health System

4. ASRA Practice Advisory

19. J Shoulder Elbow Surg. 1996 Jan-Feb;5(1):53-61 . Neurologic complications after total shoulder arthroplasty. Lynch NM , Cofield RH , Silbert PL , Hermann RC . Department of Orthopedic Surgery, Mayo Clinic and Mayo Foundation, Rochester, Minnesota, USA. Three hundred sixty-eight patients underwent 417 total shoulder arthroplasties between 1975 and 1989. Seventeen patients with 18 operated shoulders had a neurologic deficit after surgery.

25. Functional histology of a nerve fiber

31. Seddon Sunderland Structural and functional processes Neuropraxia 1 Myelin damage, conduction slowing Axonotmesis 2 Loss of axonal continuity, endoneurium intact, no conduction 3 Loss of axonal and endoneurial continuity, perineurium intact, no conduction 4 Loss of axonal and endoneurial and perineural continuity, epineurium intact, no conduction Neurotmesis 5 Entire nerve trunk separated; no conduction

32. Still with nerve injury

38. Intra-fascicular injection of lidocaine 1% in the sciatic nerve in a dog model

39. Commercial Pressure monitor device

46. NS guided sciatic nerve block at the popliteal fossa followed by US results in the finding that intra-neural injection is as common as 76% of patients

48. Vasoconstructive agent Least toxic drug Recommended doses Site of injection Resuscitation equipment And drugs Monitoring Avoid forceful and Fast injections Frequent aspiration Verbal contact Slow injection Precautions

50. MRN

51. Infection after Continuous Perineural Catheters

52. Bacterial colonization/infection after continuous nerve catheters Findings: 1- Effective postop. analgesia 2- 57% Bacterial colonization rate 3- In 6 weeks, no complications 4- one femoral paraesthesia; completely resolved in 6 months 5-The incidence of bacterial colonization was 7.5% (**) Cuvillon P Ann Fr Anesth Reanim 1998;17:991 **

61. CNS Toxicity Perioral numbness Metallic taste Light headness Tinnitus Visual disturbances Muscle twitching and tremors Seizures Coma Respiratory arrest