Postoperative neurological complications after brachial plexus block: a retrospective study conducted at a teaching hospital

Purpose Serious complications after ultrasound-guided regional anaesthesia can be devastating for the patient. The pathogenesis of postoperative neurological complications (PONC) is multifactorial and includes mechanical, vascular and chemical factors besides the nerve puncture itself. The primary aim of this study was to assess the incidence of PONC after brachial plexus block (BPB). Methods This is an observational retrospective single-centre study conducted at the regional anaesthesia unit of a teaching hospital. All BPBs performed from January 2011 to November 2019 were included. The outcomes analysed were the incidence, aetiology and diagnosis of PONCs and the incidence of other postoperative complications such as local anaesthetic systemic toxicity (LAST), pneumothorax, wrong-side block, etc. The performance of trainees and experienced anaesthesiologists was compared across all the outcomes. Results From a total of 5340 BPBs included, 15 cases developed PONC, yielding a rate of 2.81:1000 (95% CI 1.70–4.63). Thirteen patients underwent neurophysiological exams which confirmed nine neuropathies. The rate of PONCs for supervised trainees was 1.80:1000 (95% CI 0.701–4.62), not statistically different from that of experienced anaesthesiologists ( p = 0.241). Three cases were considered to present with a PONC probably related to BPB [0.562:1,00 (95% CI 0.191–1.65)]. The incidence of long-term PONCs was 1.12:1000 (95% CI 0.515–2.45). Such complications proved irreversible in 2 cases. The incidences of LAST, pneumothorax and other complications observed were 0.749:1000 (95% CI 0.291–1.92), 0.187:1000 (95% CI 0.0331–1.06) and 4.31:1000 (95% CI 2.87–6.46), respectively. Conclusions This survey suggests that complications after ultrasound-guided BPB, including blocks performed by trainees, are uncommon. Trial registration Clinicaltrials.gov ID: NCT04451642.