NAP8: Complications of Regional Anaesthesia

The patient must be under the care of an anaesthetist or Physician Assistant in Anaesthesia (legally known as Anaesthesia Associates) at the time of the index procedure. All adults and children under the care of an anaesthetist or Physician Assistant in Anaesthesia (legally known as Anaesthesia Associates) involving general anaesthesia, regional anaesthesia or analgesia, local anaesthesia or monitored anaesthesia care (i.e., care by an anaesthetist but without administration of anaesthetic drugs) will be included. This includes cases occurring in the following clinical areas:

• All elective and emergency surgical procedures undertaken in main, trauma, day surgery and maternity (labour ward and obstetric theatres)
• All isolated sites (e.g. Electroconvulsive therapy)
• Interventional pain procedures in clinic or operating theatre
• All regional anaesthetic procedures in intensive care
• Any anaesthetic, sedation, or regional anaesthetic/analgesic procedure administered by an anaesthetist or Physician Assistant in Anaesthesia (legally known as Anaesthesia Associates) in the Emergency Medicine department (See below)
• Any regional anaesthetic/analgesic procedure carried out by an anaesthetist or Physician Assistant in Anaesthesia (legally known as Anaesthesia Associates) other than for the above circumstances including in intensive care or the wards e.g. rib fracture analgesia. Post-operative rescue nerve block should be treated as a separate entry if the NAP8 activity form for that patient has already been submitted.

The complication must be related to one or more of either a central neuraxial block (epidural, caudal, spinal or CSE), a peripheral nerve block or surgical local infiltration (including surgically placed local anaesthetic wound catheters) 

• This includes attempted central neuraxial or peripheral nerve blocks that were abandoned for whatever reason
• This includes complications related to removal of any central neuraxial or peripheral nerve catheter

The complication must present during the case registry period

• If a complication presents during the case registry phase, but the original procedure occurred before the start of the case registry phase, please report.

Unless otherwise stated in the exclusion criteria for the specific complication (see Definitions of Regional anaesthesia/Local infiltration analgesia complications document below), please report all complications irrespective of the level of harm that occurred to the patient. The NAP8 team will classify level of harm using the information provided in the case registry report.

IF IN DOUBT, PLEASE REPORT.

Any complications arising in the following clinical scenarios fall outwith the scope of NAP8 and therefore should not be reported:

• Any procedures performed or complications presenting after the end of the case registry period, even if original procedure performed within the case registry phase.  

• All procedures on critical care except for regional anaesthetic/analgesic procedures (see inclusion criteria).

• Intra- or inter-hospital transfers.

• Any blocks performed by someone who is not either an anaesthetist or a Physician Assistant in Anaesthesia (legally known as Anaesthesia Associates) or is not a healthcare professional performing the procedure under the overall supervision of an anaesthetist (e.g. blocks performed by emergency medicine physicians are excluded but blocks performed by pain nurses would still fall within the NAP8 scope and should be reported).

Lumbar punctures

All exclusions do not apply if the patient has already met, or later meets, the above specified NAP8 inclusion criteria. IF IN DOUBT, PLEASE REPORT.

The following complications are included in the NAP8 scope:

Complications resulting from regional anaesthesia (central neuraxial blocks/peripheral nerve blocks) or local anaesthetic infiltration:

Central neuraxial blocks (CNB) or  peripheral nerve blocks (PNB) or local anaesthetic infiltration complications:

• Wrong route drug error
• Local anaesthetic systemic toxicity
• Pneumothorax
• Cardiac arrest due to PNB/CNB
• Infection at PNB/CNB site
• Anaphylaxis due to PNB/CNB
• Visceral or other organ injury

Central neuraxial blocks (CNB) complications only:

• High/total/complete spinal
• Respiratory failure
• Vertebral canal haematoma
• Vertebral canal abscess
• Infective meningitis
• Adhesive arachnoiditis
• Nerve injury after CNB
• Any other major CNB complication not listed above

Peripheral nerve blocks (PNB) or local anaesthetic infiltration complications only:

• Wrong site block
• Phrenic nerve palsy
• Haemorrhage
• Peripheral nerve injury due to PNB
• Any other major PNB complication not listed above

Complications NOT resulting from regional anaesthesia (general anaesthesia/sedation/monitored anaesthesia care):

• Peripheral nerve injury unrelated to direct surgical injury/CNB/PNB
• Spinal cord injury unrelated to direct surgical injury or surgical manipulation

For a full description and inclusion and exclusion criteria for each complication, please see the document below titled "NAP8 Definitions of Regional Anaesthesia/Local Infiltration Analgesia complications".

Click here to see the definitions of regional anaesthesia/local infiltration complications document

Click here to see the definitions of perioperative spinal cord or peripheral nerve injury following GA, sedation or MAC document