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Nerve injury associated with anesthesia: a closed claims analysis
F W Cheney1, K B Domino, R A Caplan
1Department of Anesthesiology, University of Washington School of Medicine, Seattle 98195, USA. fcheney@u.washington.edu
Anesthesiology
|April 14, 1999
Summary
Anesthesia-related nerve injuries are common, with ulnar nerve and brachial plexus most frequent. Current data lacks clear prevention strategies due to unknown injury mechanisms.
Area of Science:
- Anesthesiology
- Neurology
- Medical Malpractice
Background:
- Nerve injury is a significant cause of patient morbidity and anesthesiologist liability.
- Analysis of the American Society of Anesthesiologists (ASA) Closed Claims Project Database aims to identify patterns in nerve injury claims.
- This study reviews claims entered since the initial report on anesthesia-related nerve injuries.
Purpose of the Study:
- To identify recurrent and emerging patterns of anesthesia-related nerve injuries.
- To analyze the characteristics and outcomes of nerve injury claims.
- To inform potential prevention strategies for nerve damage during anesthesia.
Main Methods:
- In-depth review of anesthesia-related nerve injury claims from the ASA Closed Claims Database.
- Analysis focused on claims not included in the 1990 report.
- Categorization of injuries by nerve site, anesthetic technique, patient demographics, and symptom onset.
Main Results:
- Nerve injuries accounted for 16% (670 of 4,183) of closed claims.
- Most frequent injuries involved the ulnar nerve (28%), brachial plexus (20%), lumbosacral nerve root (16%), and spinal cord (13%).
- Ulnar nerve injuries were associated with general anesthesia, while spinal cord and lumbosacral injuries were linked to regional anesthesia. Spinal cord injuries were the leading cause of claims in the 1990s.
Conclusions:
- The mechanism of injury for most cases, especially ulnar nerve injuries, remains unclear.
- Current understanding does not support specific new prevention strategies for nerve damage.
- Further research is needed to elucidate injury mechanisms and develop effective preventative measures.
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