A Contemporary Medicolegal Analysis of Injury
Related to Peripheral Nerve Blocks
Authors: Urman Richard D. 
Published: February 2021

Background: Closed malpractice claims can provide insight into low-frequency adverse events in
many areas of perioperative and chronic pain care. Over the last decade, there have been changes
in surgical and regional anesthetic practice, likely impacting adverse event patterns. Given the wide
variability and low frequency of complications associated with peripheral nerve blocks, the study of
closed malpractice claims offers an opportunity to examine adverse events, and the patient, technical,
and provider factors that led to the claim. Knowledge gained from examination of closed claims has
already resulted in multiple improvements in processes of care and patient safety.
Objectives: An investigation of the factors that contributed to medicolegal claims against anesthesia
providers related to peripheral nerve blocks.
Study Design: Retrospective analysis.
Setting: Inpatient and outpatient surgery facilities.
Methods: The Comparative Benchmarking System database is a medical liability database that
contains more than 400,000 malpractice claims from more than 400 academic and communitybased institutions accounting for over 30% of malpractice claims in the United States. The present
investigation reviewed all (n = 113) available closed malpractice claims related to regional anesthesia
(RA) in surgical patients closed between 2006 and 2016, and investigated factors that may have
contributed to patient injury, including type of nerve block, type of surgery, nerves injured, resulting
neurologic deficits, and potential factors contributing to the injury.
Results: Our data analyzed 62 claims related to RA and showed that most closed claims were classified
as permanent minor injuries. The greatest number of claims were for brachial plexus injuries associated
with interscalene blocks performed for shoulder or rotator cuff repairs. Femoral and sciatic nerve blocks
with resulting lower extremity injuries were the most common nerve blocks resulting in payment. The
largest contributing factor to these injuries was noted to be “Technical Knowledge/Performance” of
the regionalist followed by “Pre-existing Injury/Radiculopathy.” Symptom onset from these claims was
most likely to be delayed with the leading initial presenting symptom being paresthesia.
Limitations: It is difficult to establish cause-effect relationship, and the small sample size limits the
ability to detect clinical differences and associations with specific comorbidities or techniques. There
was also limited information related to regional anesthetic techniques and medications used that
would have helped explore further relationships between the procedure and cause for litigation.
Conclusions: There remains significant room for risk reduction in regional anesthetic practice.
Patterns based on the analysis of closed claims show that interscalene blocks are the most common
peripheral nerve block resulting in litigation, even when compared with other blocks involving the
brachial plexus. Furthermore, patients with existing nerve injury/radiculopathy may also warrant
alternative techniques or greater emphasis during informed consent on the increased risk of injury. As
most of the presenting symptoms associated with claims are delayed, an opportunity for improvement
in postregional care may be better communication with patients following discharge to discuss their
postoperative recovery.
Key words: Regional, pain, anesthesia, complications, closed claims, liability, nerve, block, injury