The Second ASRA Practice Advisory on Neurologic Complications Associated with Regional Anesthesia and Pain Medicine: Executive Summary 2015

Joseph M. Neal, Michael J. Barrington, Richard Brull, Admir Hadzic, James R. Hebl, Terese T. Horlocker, Marc A. Huntoon, Sandra L. Kopp, James P. Rathmell, James Watson

Research output: Contribution to journalArticle

115 Citations (Scopus)

Abstract

Neurologic injury associated with regional anesthetic or pain medicine procedures is extremely rare. The Second American Society of Regional Anesthesia and Pain Medicine Practice Advisory on Neurologic Complications Associated With Regional Anesthesia and Pain Medicine focuses on those complications associated with mechanical, ischemic, or neurotoxic injury of the neuraxis or peripheral nervous system. As with the first advisory, this iteration does not focus on hemorrhagic or infectious complications or local anesthetic systemic toxicity, all of which are the subjects of separate practice advisories. The current advisory offers recommendations to aid in the understanding and potential limitation of rare neurologic complications that may arise during the practice of regional anesthesia and/or interventional pain medicine. What's New The Second American Society of Regional Anesthesia and Pain Medicine Practice Advisory on Neurologic Complications Associated With Regional Anesthesia and Pain Medicine updates information that was originally presented at the Society's first open forum on this subject (2005) and published in 2008. Portions of the second advisory were presented in an open forum (2012) and are herein updated, with attention to those topics subject to evolving knowledge since the first and second advisory conferences. The second advisory briefly summarizes recommendations that have not changed substantially. New to this iteration of the advisory is information related to the risk of nerve injury inherent to common orthopedic surgical procedures. Recommendations are expanded regarding the preventive role of various monitoring technologies such as ultrasound guidance and injection pressure monitoring. New clinical recommendations focus on emerging concerns including spinal stenosis and vertebral canal pathologies, blood pressure management during neuraxial anesthesia, administering blocks in anesthetized or deeply sedated patients, patients with preexisting neurologic disease, and inflammatory neuropathies. An updated diagnostic and treatment algorithm is presented.

Original languageEnglish (US)
Pages (from-to)401-430
Number of pages30
JournalRegional Anesthesia and Pain Medicine
Volume40
Issue number5
DOIs
StatePublished - Jan 1 2015

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Conduction Anesthesia
Nervous System
Medicine
Pain
Orthopedic Procedures
Nervous System Trauma
Spinal Stenosis
Preexisting Condition Coverage
Peripheral Nervous System
Wounds and Injuries
Local Anesthetics
Nervous System Diseases
Anesthetics
Anesthesia
Pathology
Blood Pressure
Technology
Pressure
Injections
Therapeutics

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine

Cite this

The Second ASRA Practice Advisory on Neurologic Complications Associated with Regional Anesthesia and Pain Medicine : Executive Summary 2015. / Neal, Joseph M.; Barrington, Michael J.; Brull, Richard; Hadzic, Admir; Hebl, James R.; Horlocker, Terese T.; Huntoon, Marc A.; Kopp, Sandra L.; Rathmell, James P.; Watson, James.

In: Regional Anesthesia and Pain Medicine, Vol. 40, No. 5, 01.01.2015, p. 401-430.

Research output: Contribution to journalArticle

Neal, Joseph M. ; Barrington, Michael J. ; Brull, Richard ; Hadzic, Admir ; Hebl, James R. ; Horlocker, Terese T. ; Huntoon, Marc A. ; Kopp, Sandra L. ; Rathmell, James P. ; Watson, James. / The Second ASRA Practice Advisory on Neurologic Complications Associated with Regional Anesthesia and Pain Medicine : Executive Summary 2015. In: Regional Anesthesia and Pain Medicine. 2015 ; Vol. 40, No. 5. pp. 401-430.
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