Can You Fix With a Knife What Was Damaged by a Needle? A Surgical Algorithm To Treat Pain After Injection Injuries.
Matthew Wordsworth, FRCS(Plast)1, Julie M West, MS, PA-C1, AnneMarie Miralia, PA-C1, Luke T Juckett, BA, BS1, Jason M Souza, MD2 and Amy M Moore, MD1, 1The Ohio State University Wexner Medical Center, Columbus, OH, 2Plastic Surgery, The Ohio State University, Columbus, OH
Introduction:
Nerve injury after regional nerve block is rare, but when it occurs it can result in functional loss, debilitating pain, or both. A peripheral nerve can be injured during nerve block physically - by direct trauma of the needle, chemically - through toxicity of the infiltrate, and compressively - by the infiltrated fluid or a hematoma. The rate of persistent nerve injury after nerve block is reported as between 2-4 per 10,000 cases. This is rate low enough that a single provider may never encounter it, but common enough against an estimated 500,000 peripheral nerve blocks per annum in the US that potentially up to 200 patients a year are affected. An exact framework for treatment options of patients with nerve injury after peripheral nerve blocks has not been established. The purpose of this study is to report our experience with the surgical management of these patients and establish a treatment algorithm based on time of presentation and symptoms.
Materials and Methods:
A retrospective review was conducted to identify patients who presented to our peripheral nerve clinic between 2020 and 2023 with peripheral nerve block associated injuries. Demographic data, past medical and surgical history were extracted. Preoperative and postoperative outcomes were recorded.
Results:
Seven patients with nerve block injury were identified. Nerve injuries involved the phrenic nerve, the axillary nerve and, in lower limb the sciatic, peroneal, and tibial nerves. Surgical exploration, intraneurolysis and nerve transfers were performed. At a minimum of 6months of follow-up, significant improvement in pain on VAS and function was found.
Conclusions:
This study presents our peripheral nerve unit’s experience with the surgical management of persistent nerve injury after regional nerve block. We present a case series of upper limb, lower limb and cervical nerve injuries from nerve blocks. We highlight commonalities in the history and progression of symptoms such as severe neuropathic pain affecting blocked anatomical area starting immediately post operatively or once the anesthetic effects of the block have resolved and not improving over the first 6 weeks. Surgical intervention including neurolysis can be beneficial.
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