Complications of Regional Anesthesia: A Comprehensive Review of Neurological Injury, Hematoma, and Infection
DOI:
https://doi.org/10.12775/QS.2025.48.66988Keywords
aneshesia, pediatric anesthesia, spinal anesthesia, Nerve block, complications, local anesthesia, difficult anesthesiaAbstract
Background. Regional anesthesia is increasingly used due to its advantages over general anesthesia; however, its potential complications require careful evaluation.
Aim. This review aimed to synthesize current evidence on the incidence, risk factors, and prevention of neurological injury, hematoma, and infection associated with regional anesthesia.
Material and methods. Relevant peer-reviewed literature—including systematic reviews, retrospective cohorts, and randomized trials—was analyzed to provide a comprehensive overview.
Results. Neurological complications, though uncommon, may persist in a subset of patients and are linked to factors such as high-pressure intrafascicular injection and inadequate needle guidance. Hematomas remain rare but are more likely in patients on anticoagulants and can result in permanent deficits if diagnosis and decompression are delayed. Infections, particularly with prolonged catheter use, present a serious risk, with higher rates in peripheral nerve blocks and pediatric populations.
Conclusions. Preventive strategies include ultrasound guidance, triple safety protocols, careful antithrombotic management, and strict aseptic techniques. Recent evidence supports the efficacy of real-time pressure monitoring and prophylactic antibiotic use in reducing adverse outcomes. This review underscores the importance of patient-specific risk assessment and adherence to evolving safety protocols in minimizing complications from regional anesthesia.
References
1. Mason, L. and T. Jackman, Comparative Analysis of Regional versus General Anesthesia. Journal of Student Research, 2021. 9(2).
2. Vacchiano, M.E., E.T. Haupt, and K. Aziz, Foot and Ankle Surgery Postoperative Complications with Regional vs General Anesthesia. Foot & Ankle Orthopaedics, 2023. 8(4).
3. Radkowski, P., et al., Neurological Complications of Regional Anesthesia: An Updated Review with Clinical Guidelines. Medical Science Monitor, 2023. 29.
4. Campos, M.G., et al., Assessment of main complications of regional anesthesia recorded in an acute pain unit in a tertiary care university hospital: a retrospective cohort. Brazilian Journal of Anesthesiology (English Edition), 2022. 72(5): p. 605-613.
5. Selvamani, B.J., et al., Infectious complications following regional anesthesia: a narrative review and contemporary estimates of risk. Regional Anesthesia & Pain Medicine, 2024: p. rapm-2024-10549.
6. Hill, K. and A. Macfarlane, Jr., Does regional anaesthesia improve outcome? Anaesthesia & Intensive Care Medicine, 2018. 19(11): p. 619-623.
7. Tankard, K.A., et al., The Effect of Regional Anesthesia on Outcomes After Minimally Invasive Ivor Lewis Esophagectomy. Journal of Cardiothoracic and Vascular Anesthesia, 2020. 34(11): p. 3052-3058.
8. Horlocker, T.T., Complications of regional anesthesia. European Journal of Pain Supplements, 2010. 4(S4): p. 227-234.
9. Zin, N., Neurological complications in obstetric regional anaesthesia. Anaesthesia & Intensive Care Medicine, 2022. 23(8): p. 431-436.
10. Puthenveettil, N., et al., Foot Drop following Neuraxial Anaesthesia: A Case Report. Sri Lankan Journal of Anaesthesiology, 2021. 29(1): p. 62-63.
11. Cortés-Badillo, L.D., et al., Neuroaxial anesthesia caused paraplegia: a case report. International Journal of Research in Medical Sciences, 2021. 9(6): p. 1754.
12. Beethe, A.R., et al., Neuraxial and regional anesthesia in surgical patients with osteogenesis imperfecta: a narrative review of literature. Regional Anesthesia & Pain Medicine, 2020. 45(12): p. 993-999.
13. Vu, K.V., et al., Cervical Spinal Epidural Hematoma After Spinal Anesthesia for Cesarean Section in the Parturient Using Long‐Term Low Dose Aspirin. Case Reports in Anesthesiology, 2024. 2024(1).
14. Schieber, M.R., et al., Influence of antithrombotic medication on size and neurological outcome of spinal epidural hematoma after neuraxial anesthesia: a systematic review. Regional Anesthesia & Pain Medicine, 2025. 50(1): p. 20-25.
15. Benzon, H.T., et al., Literature review of spinal hematoma case reports: causes and outcomes in pediatric, obstetric, neuraxial and pain medicine cases. Regional Anesthesia & Pain Medicine, 2024. 49(12): p. 900-906.
16. Sanders, R.A., et al., Epidural Hematoma Following Interlaminar Epidural Injection in Patient Taking Aspirin. Regional Anesthesia and Pain Medicine, 2018: p. 1.
17. Kirkham, K. and E. Albrecht, Perioperative Coagulation in Neuraxial and Peripheral Nerve Blocks. 2015, Springer Berlin Heidelberg. p. 365-373.
18. Kokubo, R., et al., Epidural anesthesia masking pain from spinal epidural hematoma. Nepal Journal of Neuroscience, 2019. 16(2): p. 43-45.
19. Baeesa, S., et al., Spontaneous Spinal Epidural Hematoma: Correlation of Timing of Surgical Decompression and MRI Findings with Functional Neurological Outcome. World Neurosurgery, 2019. 122: p. e241-e247.
20. Cortina, G., et al., Spinal hematoma after total knee arthroplasty: a case report. Journal of Surgical Case Reports, 2021. 2021(8).
21. Wang, M., P. Zhou, and S. Jiang, Clinical Features, Management, and Prognostic Factors of Spontaneous Epidural Spinal Hematoma: Analysis of 24 Cases. World Neurosurgery, 2017. 102: p. 360-369.
22. Walker, B.J., et al., Complications in Pediatric Regional Anesthesia. Anesthesiology, 2018. 129(4): p. 721-732.
23. Bomberg, H., et al., Single-dose Antibiotic Prophylaxis in Regional Anesthesia. Anesthesiology, 2016. 125(3): p. 505-515.
24. Domingues, C., et al., Epidural Catheter Bacterial Colonization and Infection in a Secondary Portuguese Hospital Setting. Cureus, 2024.
25. Zorrilla-Vaca, A., et al., Epidemiology of septic meningitis associated with neuraxial anesthesia: a historical review and meta-analysis. Minerva Anestesiologica, 2018. 84(3).
26. Ecoffey, C., et al., Practice advisory on the prevention and management of complications of pediatric regional anesthesia. J Clin Anesth, 2022. 79: p. 110725.
27. Brull, R., et al., Neurological complications after regional anesthesia: contemporary estimates of risk. Anesth Analg, 2007. 104(4): p. 965-74.
28. Kohan, J., et al., Upper Extremity Blocks for Hand Surgeons: A Literature Review of Regional Anaesthesia Techniques, Efficacy, and Safety. Plastic Surgery, 2024. 32(4): p. 667-676.
29. Frost, S., et al., Postoperative neurological symptoms following arthroscopic shoulder surgery with interscalene block: an exploratory secondary analysis of pooled randomized controlled trial data. Regional Anesthesia & Pain Medicine, 2023. 48(11): p. 553-560.
30. Siddiqui, S., et al., One-year outcomes after regional Anesthesia. Indian Journal of Pain, 2016. 30(3): p. 186.
31. Helander, E.M., et al., Regional Nerve Blocks—Best Practice Strategies for Reduction in Complications and Comprehensive Review. Current Pain and Headache Reports, 2019. 23(6).
32. Reina, M.A., et al., Extrafasicular and Intraperineural, but No Endoneural, Spread after Deliberate Intraneural Injections in a Cadaveric Study. Anesthesiology, 2019. 130(6): p. 1007-1016.
33. Coudray, A., et al., Combination of real-time needle-tip pressure sensing and minimal intensity stimulation limits unintentional intraneural injection during an ultrasound-guided peripheral nerve block procedure: A randomized, parallel group, controlled trial. Journal of Clinical Anesthesia, 2021. 74: p. 110420.
34. Neal, J.M., et al., Neurological Complications Associated With Regional The Second ASRA Practice Advisory on Anesthesia and Pain Medicine: Executive Summary 2015. Obstetric Anesthesia Digest, 2016. 36(3): p. 124-124.
35. Steinfeldt, T., et al., Injection pressure monitoring at the needle tip for detection of perineural and nerve-contact position: a cadaver study. Canadian Journal of Anesthesia/Journal canadien d'anesthésie, 2020. 67(8): p. 1076-1077.
36. Phan, K.H., J.G. Anderson, and D.R. Bohay, Complications Associated with Peripheral Nerve Blocks. Orthopedic Clinics of North America, 2021. 52(3): p. 279-290.
37. Poredoš, P., Peripheral Nerve Blocks in Patients on Antithrombotic Drugs – a Rescue or an Unnecessary Risk? Acta Clinica Croatica, 2022.
38. Balboni, J., et al., Neurologic Complications Following Peripheral Nerve Block in Foot and Ankle Surgery. JBJS Reviews, 2024. 12(8).
39. Trivedi, S.M., et al., Long-term Complications From Peripheral Nerve Blocks After Pediatric Orthopaedic Lower Extremity Procedures: A Systematic Review. The American Journal of Sports Medicine, 2025. 53(4): p. 981-987.
40. Lauf, J.A., et al., Regional Nerve Block Complication Analysis Following Peripheral Nerve Block During Foot and Ankle Surgical Procedures. Cureus, 2020.
41. Dabbagh, A., et al., Experimental implementation of the peripheral nerve block clinical registry: an observational study. Frontiers in Medicine, 2025. 12.
42. Perkins, L., et al., Continuous peripheral nerve blocks for burn management: a retrospective study of outcomes and complications in 281 burn patients. Regional Anesthesia & Pain Medicine, 2024: p. rapm-2024-10593.
43. Macdonald, J. and D.-A. Zhang, Prolonged Use of a Continuous Peripheral Nerve Block Catheter for Analgesia after Pediatric Foot and Ankle Surgery. Case Reports in Anesthesiology, 2021. 2021: p. 1-3.
44. Chun, Y., M. Phillips, and S. Suresh, Updates on neurologic complications in pediatric regional anesthesia. Minerva Anestesiologica, 2021. 87(6).
45. Stinson, Z., et al., Regional and Local Anesthesia in Pediatric Orthopaedic Surgery. Journal of the Pediatric Orthopaedic Society of North America, 2022. 4(4): p. 579.
46. Lam, K.K., et al., Incidence and etiology of postoperative neurological symptoms after peripheral nerve block: a retrospective cohort study. Regional Anesthesia & Pain Medicine, 2020. 45(7): p. 495-504.
47. Clebone, A., Special Considerations of Regional Anesthesia in Pediatric Patients. 2021, Oxford University Press. p. 67-70.
48. Gupta, R.K. and E.S. Schwenk, Local anesthetic systemic toxicity in children: a review of recent case reports and current literature - an infographic. Regional Anesthesia & Pain Medicine, 2021. 46(10): p. 915-915.
49. Singaravelu Ramesh, A. and K. Boretsky, Local anesthetic systemic toxicity in children: a review of recent case reports and current literature. Regional Anesthesia & Pain Medicine, 2021. 46(10): p. 909-914.
50. Cung, S., M.L. Ritz, and M.M. Masaracchia, Regional anesthesia in pediatric patients with preexisting neurological disease. Pediatric Anesthesia, 2021. 31(5): p. 522-530.
51. Jarraya, A., et al., Incidence of complications after nonoperating room anesthesia in children in a low‐ and middle‐income country: A prospective and observational study. Pediatric Anesthesia, 2024. 34(10): p. 1053-1062.
52. Ecoffey, C., et al., Practice advisory on the prevention and management of complications of pediatric regional anesthesia. Journal of Clinical Anesthesia, 2022. 79: p. 110725.
53. Chen, S., et al., Preoperative Antisepsis with Chlorhexidine Versus Povidone‐Iodine for the Prevention of Surgical Site Infection: a Systematic Review and Meta‐analysis. World Journal of Surgery, 2020. 44(5): p. 1412-1424.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2025 Marta Bonarska, Damian Adasik, Katarzyna Herjan, Katarzyna Chmura, Barbara Zimnoch, Katarzyna Rendaszka, Marta Pyziołek, Paulina Kwaśniewska, Małgorzata Stróżna, Joanna Monika Najbar, Katarzyna Kowalska
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
Stats
Number of views and downloads: 8
Number of citations: 0
