The AANA Foundation Closed Malpractice Claims Study on nerve injuries during anesthesia care

Anesthesia-associated nerve injury is a common cause of patient morbidity and litigation. To identify factors associated with perioperative nerve injuries and rationalize preventive strategies, 44 cases from the American Association of Nurse Anesthetists (AANA) Foundation Closed Malpractice Claims Database pertaining to nerve injuries in which nurse anesthetists provided care were analyzed. Emerging patterns and themes related to the development of injury were identified. The database is a collection of medical liability claims filed against CRNAs insured by the St Paul Fire and Marine Insurance Company; 44 claims of anesthesia-related nerve injury were analyzed. The most common injury was to the brachial plexus (15 [34%]), followed by ulnar nerve injury (7 [16%]), radial nerve injury (5 [11%]), peroneal nerve injury (4 [9%]), paraplegia (4 [9%]), lumbosacral injury (3[7%]), and a variety of "other" injuries (8[18%]). These numbers and percentages total more than 44 (100%) as some patients incurred multiple injuries. Documentation on the anesthesia record of the use of intraoperative protective padding and patient position was lacking or inadequate in a majority of the claims. Effective strategies for the prevention of nerve injury during anesthesia are reviewed. Abnormal body habitus, several disease states, anesthesia technique, improper positioning, lack of adequate padding, and tourniquet use have been implicated as risk factors.