Regional anaesthesia complications

complications local anaesthetic nerve blocks regionalanaesthesia Nov 10, 2025

When the block bites back - complications of regional anaesthesia
Regional anaesthesia is an invaluable tool in perioperative care, offering targeted pain relief and reduced opioid requirements 🏥. However, like any procedure, there is always a risk of complications and adverse events, for which we must vigilantly monitor.

Common complications include:
🔸 block failure or incomplete anaesthesia
🔸 nerve injury
🔸 vascular puncture or haematoma
🔸 infection
🔸 unintended block spread

Minor, transient symptoms such as localised bruising or temporary numbness are relatively common, while serious adverse events are rare. Important and essential preventive measures include a pre-block assessment, correct positioning, and adherence to aseptic technique during the procedure 🌿.

Despite strict measures to reduce their likelihood, complications still occur. Here’s a breakdown of some of the adverse events that may occur:

Neurological complications may present as
🔸 prolonged numbness
🔸 weakness
🔸 neuropathic pain

Most resolve spontaneously, but persistent or progressive deficits warrant urgent review ❤️. Accurate baseline and serial neurovascular observations — including motor strength, sensation, and pain scores — allow early detection.

Vascular and bleeding complications
🔸 especially in anticoagulated patients or where deep blocks are performed
🔸 monitor for swelling, firmness, or signs of compartment syndrome and escalate promptly

Infective complications
🔸 uncommon but serious
🔸 Monitor for redness, warmth, discharge, or systemic signs of infection (particularly when catheters remain in situ)
🔸 Meticulous hand hygiene and catheter site care reduce risk 😴

Local anaesthetic systemic toxicity (LAST)
🔸 while uncommon, remains an important consideration whenever local anaesthetic is administered. Recognition and management of LAST will be discussed in its own concept series article, but nurses should always ensure resuscitation equipment and lipid emulsion therapy are readily available.

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References:

Australian and New Zealand College of Anaesthetists. (2014). PS03: Guidelines for the management of major regional analgesia (Professional document). ANZCA. http://hdl.handle.net/11055/21

Barrington, M. J., Watts, S. A., Gledhill, S. R., Thomas, R. D., Said, S. A., Snyder, G. L., Tay, V. S., & Jamrozik, K. (2009). Preliminary results of the Australasian Regional Anaesthesia Collaboration: A prospective audit of more than 7,000 peripheral nerve and plexus blocks for neurologic and other complications. Regional Anesthesia and Pain Medicine, 34(6), 534–541. https://doi.org/10.1097/AAP.0b013e3181ae72e8

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