Perioperative Nerve Injury after Peripheral Nerve Block in Patients with Previous Systemic Chemotherapy

Arnoley S. Abcejo, Hans P. Sviggum, Michelle M Mauermann, James R. Hebl, Carlos Bernardo Mantilla, Andrew C. Hanson, Yi Lin, Adam K. Jacob

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Background and Objectives There are multiple risk factors for developing perioperative nerve injury (PNI). Perioperative nerve injury after peripheral nerve blockade (PNB) is rare. Exposure to systemic chemotherapy may cause peripheral neuropathy, but its role as a risk factor for PNI after PNB is unknown. The objective of this retrospective study was to determine the incidence of PNI in patients undergoing PNB as part of extremity surgery after prior exposure to systemic chemotherapy. Methods All patients aged 18 years or older who received systemic chemotherapy and subsequently underwent PNB were identified. The primary outcome was defined as the presence of new or worsened PNI documented within 3 months of the procedural date. Cases of PNI were independently reviewed by 3 investigators, and the etiology of all PNI cases were categorized as possibly or unlikely related to the PNB. Results A total of 216 PNB (165 lower extremity blocks, 51 upper extremity blocks) were performed in 186 patients previously exposed to chemotherapy; 4 cases met criteria for PNI (2.2%; 95% confidence interval, 0.8%-5.4%). One case of PNI was possibly related to PNB (0.5%; 95% confidence interval, 0.1%-3.0%) and 3 cases were unlikely related to PNB. Complete recovery occurred in 3 cases, with partial recovery occurring in 1. Conclusions The overall incidence of PNI in this cohort (2.2%) was not different than baseline risk established in large cohort studies. Perioperative nerve injury was possibly attributable to the PNB in 0.5% of patients. However, in the absence of a control group of surgical patients who previously received systemic chemotherapy without regional anesthesia, we cannot determine whether the higher incidence of neurologic injury is secondary to the surgical procedure, the anesthetic technique, the natural progression of chemotherapy-induced peripheral neuropathy, or a combination of factors and the relative contribution of each.

Original languageEnglish (US)
Pages (from-to)685-690
Number of pages6
JournalRegional Anesthesia and Pain Medicine
Volume41
Issue number6
DOIs
StatePublished - Nov 1 2016

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Peripheral Nerve Injuries
Nerve Block
Peripheral Nerves
Drug Therapy
Wounds and Injuries
Peripheral Nervous System Diseases
Incidence
Confidence Intervals
Nervous System Trauma
Conduction Anesthesia
Upper Extremity
Anesthetics
Lower Extremity
Cohort Studies
Extremities
Retrospective Studies
Research Personnel
Control Groups

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine

Cite this

Perioperative Nerve Injury after Peripheral Nerve Block in Patients with Previous Systemic Chemotherapy. / Abcejo, Arnoley S.; Sviggum, Hans P.; Mauermann, Michelle M; Hebl, James R.; Mantilla, Carlos Bernardo; Hanson, Andrew C.; Lin, Yi; Jacob, Adam K.

In: Regional Anesthesia and Pain Medicine, Vol. 41, No. 6, 01.11.2016, p. 685-690.

Research output: Contribution to journalArticle

Abcejo, Arnoley S. ; Sviggum, Hans P. ; Mauermann, Michelle M ; Hebl, James R. ; Mantilla, Carlos Bernardo ; Hanson, Andrew C. ; Lin, Yi ; Jacob, Adam K. / Perioperative Nerve Injury after Peripheral Nerve Block in Patients with Previous Systemic Chemotherapy. In: Regional Anesthesia and Pain Medicine. 2016 ; Vol. 41, No. 6. pp. 685-690.
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abstract = "Background and Objectives There are multiple risk factors for developing perioperative nerve injury (PNI). Perioperative nerve injury after peripheral nerve blockade (PNB) is rare. Exposure to systemic chemotherapy may cause peripheral neuropathy, but its role as a risk factor for PNI after PNB is unknown. The objective of this retrospective study was to determine the incidence of PNI in patients undergoing PNB as part of extremity surgery after prior exposure to systemic chemotherapy. Methods All patients aged 18 years or older who received systemic chemotherapy and subsequently underwent PNB were identified. The primary outcome was defined as the presence of new or worsened PNI documented within 3 months of the procedural date. Cases of PNI were independently reviewed by 3 investigators, and the etiology of all PNI cases were categorized as possibly or unlikely related to the PNB. Results A total of 216 PNB (165 lower extremity blocks, 51 upper extremity blocks) were performed in 186 patients previously exposed to chemotherapy; 4 cases met criteria for PNI (2.2{\%}; 95{\%} confidence interval, 0.8{\%}-5.4{\%}). One case of PNI was possibly related to PNB (0.5{\%}; 95{\%} confidence interval, 0.1{\%}-3.0{\%}) and 3 cases were unlikely related to PNB. Complete recovery occurred in 3 cases, with partial recovery occurring in 1. Conclusions The overall incidence of PNI in this cohort (2.2{\%}) was not different than baseline risk established in large cohort studies. Perioperative nerve injury was possibly attributable to the PNB in 0.5{\%} of patients. However, in the absence of a control group of surgical patients who previously received systemic chemotherapy without regional anesthesia, we cannot determine whether the higher incidence of neurologic injury is secondary to the surgical procedure, the anesthetic technique, the natural progression of chemotherapy-induced peripheral neuropathy, or a combination of factors and the relative contribution of each.",
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T1 - Perioperative Nerve Injury after Peripheral Nerve Block in Patients with Previous Systemic Chemotherapy

AU - Abcejo, Arnoley S.

AU - Sviggum, Hans P.

AU - Mauermann, Michelle M

AU - Hebl, James R.

AU - Mantilla, Carlos Bernardo

AU - Hanson, Andrew C.

AU - Lin, Yi

AU - Jacob, Adam K.

PY - 2016/11/1

Y1 - 2016/11/1

N2 - Background and Objectives There are multiple risk factors for developing perioperative nerve injury (PNI). Perioperative nerve injury after peripheral nerve blockade (PNB) is rare. Exposure to systemic chemotherapy may cause peripheral neuropathy, but its role as a risk factor for PNI after PNB is unknown. The objective of this retrospective study was to determine the incidence of PNI in patients undergoing PNB as part of extremity surgery after prior exposure to systemic chemotherapy. Methods All patients aged 18 years or older who received systemic chemotherapy and subsequently underwent PNB were identified. The primary outcome was defined as the presence of new or worsened PNI documented within 3 months of the procedural date. Cases of PNI were independently reviewed by 3 investigators, and the etiology of all PNI cases were categorized as possibly or unlikely related to the PNB. Results A total of 216 PNB (165 lower extremity blocks, 51 upper extremity blocks) were performed in 186 patients previously exposed to chemotherapy; 4 cases met criteria for PNI (2.2%; 95% confidence interval, 0.8%-5.4%). One case of PNI was possibly related to PNB (0.5%; 95% confidence interval, 0.1%-3.0%) and 3 cases were unlikely related to PNB. Complete recovery occurred in 3 cases, with partial recovery occurring in 1. Conclusions The overall incidence of PNI in this cohort (2.2%) was not different than baseline risk established in large cohort studies. Perioperative nerve injury was possibly attributable to the PNB in 0.5% of patients. However, in the absence of a control group of surgical patients who previously received systemic chemotherapy without regional anesthesia, we cannot determine whether the higher incidence of neurologic injury is secondary to the surgical procedure, the anesthetic technique, the natural progression of chemotherapy-induced peripheral neuropathy, or a combination of factors and the relative contribution of each.

AB - Background and Objectives There are multiple risk factors for developing perioperative nerve injury (PNI). Perioperative nerve injury after peripheral nerve blockade (PNB) is rare. Exposure to systemic chemotherapy may cause peripheral neuropathy, but its role as a risk factor for PNI after PNB is unknown. The objective of this retrospective study was to determine the incidence of PNI in patients undergoing PNB as part of extremity surgery after prior exposure to systemic chemotherapy. Methods All patients aged 18 years or older who received systemic chemotherapy and subsequently underwent PNB were identified. The primary outcome was defined as the presence of new or worsened PNI documented within 3 months of the procedural date. Cases of PNI were independently reviewed by 3 investigators, and the etiology of all PNI cases were categorized as possibly or unlikely related to the PNB. Results A total of 216 PNB (165 lower extremity blocks, 51 upper extremity blocks) were performed in 186 patients previously exposed to chemotherapy; 4 cases met criteria for PNI (2.2%; 95% confidence interval, 0.8%-5.4%). One case of PNI was possibly related to PNB (0.5%; 95% confidence interval, 0.1%-3.0%) and 3 cases were unlikely related to PNB. Complete recovery occurred in 3 cases, with partial recovery occurring in 1. Conclusions The overall incidence of PNI in this cohort (2.2%) was not different than baseline risk established in large cohort studies. Perioperative nerve injury was possibly attributable to the PNB in 0.5% of patients. However, in the absence of a control group of surgical patients who previously received systemic chemotherapy without regional anesthesia, we cannot determine whether the higher incidence of neurologic injury is secondary to the surgical procedure, the anesthetic technique, the natural progression of chemotherapy-induced peripheral neuropathy, or a combination of factors and the relative contribution of each.

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