Updated Retrospective Single-Center Comparative Analysis of Peripheral Nerve Block Complications Using Landmark Peripheral Nerve Stimulation Versus Ultrasound Guidance as a Primary Means of Nerve Localization.

OBJECTIVES: The purpose of this study was to perform an updated analysis of complications associated with upper and lower extremity peripheral nerve blocks (PNBs) performed with ultrasound (US) guidance versus the landmark approach. METHODS: We conducted a single-center retrospective cohort analysis to compare the incidence of PNB complications between the techniques. The primary outcome was local anesthetic systemic toxicity (LAST), whereas the secondary outcomes included short- and long-term nerve injuries. The current query included cases performed between 2012 and 2015. A combined analysis included data extending to 2006. The Statistical examination relied on the χ2 test. RESULTS: During this 4-year period, we performed 7789 US-guided and 498 landmark-guided blocks with no statistically significant difference in the incidence of nerve injury or LAST between the groups. Our 10-year analysis, however, revealed a significant increase (P < .01) in the rate of LAST with the landmark technique: 7 of 5932 versus 0 of 16,858 cases. The combined data also revealed a significant increase (P < .01) in short-term injuries associated with the landmark approach (30 of 5932 versus 33 of 16,858) but no significant difference in the incidence of long-term injuries. CONCLUSIONS: Our analysis supports a conclusion that the use of US guidance during PNBs leads to a significant reduction in the incidence of LAST, adding to growing evidence from similar investigations. The impact of US on the incidence of nerve injuries remains unclear, considering that the nature of transient deficits is thought to be multifactorial, and the frequency of lasting injuries did not differ significantly in this study.

Anesthesia and postoperative analgesia: outcomes following orthopedic surgery.

The demand for increased efficiency and decreased hospital stay has magnified the role of anesthesia and acute postoperative pain management in orthopedics. Orthopedic anesthesia and acute postoperative pain management, which are subspecialties of anesthesiology, are increasingly recognized for their positive effect on the length of hospital stay, functional recovery, and patient satisfaction. Recently, there has been a resurgence in the use of continuous nerve block techniques for postoperative pain management. These techniques have been shown to be effective and safe in controlling postoperative pain, both at rest and during physical therapy, even in anticoagulated patients. The use of peripheral nerve blocks for anesthesia has been associated with earlier discharge when compared with general anesthesia and neuraxial blocks in patients undergoing ambulatory orthopedic surgery. Regional techniques are usually part of a multimodal strategy that includes both pharmacological and nonpharmacological approaches to pain management.