Injuries associated with regional anesthesia in the 1980s and 1990s: a closed claims analysis

Anesthesiology. 2004 Jul;101(1):143-52. doi: 10.1097/00000542-200407000-00023.


Background: The authors used the American Society of Anesthesiologists Closed Claims Project database to identify specific patterns of injury and legal liability associated with regional anesthesia. Because obstetrics represents a unique subset of patients, claims with neuraxial blockade were divided into obstetric and nonobstetric groups for comparison.

Methods: The American Society of Anesthesiologists Closed Claims Project is a structured evaluation of adverse anesthetic outcomes collected from closed anesthesia malpractice insurance claims of professional liability companies. An in-depth analysis of 1980-1999 regional anesthesia claims was performed with a subset comparison between obstetric and nonobstetric neuraxial anesthesia claims.

Results: Of the total 1,005 regional anesthesia claims, neuraxial blockade was used in 368 obstetric claims and 453 of 637 nonobstetric claims (71%). Damaging events in 51% of obstetric and 41% of nonobstetric neuraxial anesthesia claims were block related. Obstetrics had a higher proportion of neuraxial anesthesia claims with temporary and low-severity injuries (71%) compared with the nonobstetric group (38%; P <or=0.01) and a lower proportion of claims with death or brain damage and permanent nerve injury compared with the nonobstetric group (P <or= 0.01). Cardiac arrest associated with neuraxial block was the primary damaging event in 32% of obstetric and 38% of nonobstetric neuraxial anesthesia claims involving death or brain damage. Eye blocks accounted for 5% of regional anesthesia claims.

Conclusion: Obstetric claims were predominately associated with minor injuries. Permanent injury from eye blocks increased in the 1990s. Neuraxial cardiac arrest and neuraxial hematomas associated with coagulopathy remain sources of high-severity injury.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Anesthesia, Conduction / adverse effects*
  • Anesthesia, Obstetrical / adverse effects
  • Blood Coagulation Disorders / chemically induced
  • Blood Coagulation Disorders / epidemiology
  • Brain Damage, Chronic / chemically induced
  • Brain Damage, Chronic / epidemiology
  • Databases, Factual
  • Eye Injuries / epidemiology
  • Female
  • Heart Arrest / chemically induced
  • Heart Arrest / epidemiology
  • Hematoma / epidemiology
  • Hematoma / etiology
  • Humans
  • Insurance
  • Insurance Claim Review / economics
  • Insurance Claim Review / statistics & numerical data*
  • Liability, Legal
  • Malpractice / economics
  • Malpractice / statistics & numerical data
  • Nerve Block / adverse effects
  • Peripheral Nerve Injuries
  • Pregnancy
  • Treatment Outcome