In neural dysfunction after regional anesthesia (NDRA), a rare complication of peripheral blocks, patients experience unexpected pain, numbness and weakness. It's distressing for all involved. Neuropathic symptoms lead to physical and mental suffering.
At the University of Iowa, clinicians addressed the matter by establishing the Regional Anesthesia Follow-up Clinic (RAFC) in June 2009. Before its launch, there was no organized mechanism for post-operative reporting, evaluation and management of patients with apparent NDRA after orthopedic surgery. Dismayed, some surgeons requested that regional anesthesia not be used with their patients. Consequently, many patients endured difficult post-operative pain management.
Patients with suspected NDRA come to the clinic from widespread referral sources, according to an article in the Summer 2011 International Anesthesiology Clinics. They are interviewed and examined as both a screening and a consultation service. The clinic's goals are to make an initial working diagnosis, and to recommend testing, physicial therapy, medications, and further consultations.
In the clinic's first 15 months, the orthopedic surgery service referred 16 patients with suspected NDRA. A total of 4,363 peripheral nerve blocks were performed during this time. Of the 16 patients referred for possible NDRA, 2 (12.5%) were not block-related, 2 (12.5%) have since fully resolved, 6 (37.5%) are nearly resolved and 6 (37.5%) are improving but not yet resolved. Overall, 14 of 4,363 (0.32%) of patients had some evidence of short-term peripheral neuropathy attributable presumably to peripheral nerve block.
Since launching the RAFC, surgeons who earlier wanted to eliminate regional anesthesia from their procedures report seeing fewer problems from nerve blocks. They also feel more confident in the safety of the procedures.
Rob Murphy
