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Advantages & Issues

   

Jeff Gadsden, MD. Published by B. Braun Medical Inc.


Advantages of an Injection Safety Monitoring Approach

Recent evidence has emerged to suggest that the use of multiple monitors during nerve blockade—particularly ultrasonography, nerve stimulation and injection pressure monitoring—provides the optimal environment with which to avoid nerve injury.1


The use of synergistic, complementary monitors provides  a greater level of “situational awareness” to help guide more informed decisions on needle placement and injection. The  strength of each monitor can be leveraged to cover the limitations of another.



The nerve block procedure can be documented with clear, objective values that can be communicated in the future.

The incidence of complications from general anesthesia has been reduced significantly in recent decades, largely due to advances in cardiorespiratory monitoring.2 The use of objective monitors such as pulse oximetry and capnography allow practitioners to quickly identify changing physiologic parameters and intervene quickly and effectively. The practice of regional anesthesia has traditionally lacked a set of similar objective monitors that aid the practitioner in preventing injury.

Peripheral nerve blockade is a widely practiced technique used to provide pain control during and after surgical procedures. While nerve blocks are very effective and generally considered safe, there remain some risks associated with their performance.3

Nerve injury and resulting postoperative neurologic dysfunction (PONS) is a feared complication of peripheral nerve blockade. Estimates of its incidence vary from as little as 0.18% to as much as 16%, depending on the site the block was performed on and the technique.3, 4-6 The majority of neurologic symptoms following nerve blockade are transient and last days to weeks, but some are permanent and can result in profound disability.

Not only does the patient suffer the physical and emotional burden of a prolonged or permanent injury, there are other costs associated with these adverse events. These include the cost of prolonged length of stay and/or neurologic testing, the emotional and financial strain of missed work, and the negative impact on the patient’s day-to-day quality of life. Many patients with long-term nerve injuries following a nerve block eventually seek compensation through the legal system, incurring further expenses for both the patient and for the caregivers and facility.