Evaluation of Neurologic Injury Following Regional Anesthesia

Modern anesthesia is a highly predictable undertaking with a very low failure rate. The ability to produce successful anesthesia is a less important characteristic of excellent anesthetic practice than the ability to recognize and treat adverse perioperative events. Recognition of myocardial ischemia or prompt treatment of catastrophic bleeding are examples of the situations requiring careful diagnosis and calm, decisive action. This same approach should prevail when the adverse event is a neurologic complication of regional anesthesia, only there is an added difficulty. At few other times in the practice of anesthesia will a practitioner be so directly confronted with responsibility for an adverse outcome as with a complication from neural blockade, because in a sense the “smoking gun” is clearly in our hands. Additional opprobrium may stem from the common misconceptions that complication rates should be zero in the practice of anesthesiology, and that the complication would not have occurred if only a general anesthetic had been performed.