Practical tips on making regional anesthesia safer

Abstract

There have been many advances in regional anesthesia to make it safer since its inception. The purpose of the review is to make the readers aware of the latest developments in the approach to patient safety and its application to regional anesthesia. We have emphasized particularly the importance of human factors in addition to the technical expertise. Besides the conventional topics of local anesthetic toxicity and nerve injuries, we have also touched on novel developments such as point-of-care ultrasound. Anesthetists should bear in mind that guidelines are designed to encourage safe and quality patient care, but they cannot guarantee a specific outcome. So where possible safety protocols like pre-procedure dedicated checklist, vigilance and enhancements in monitoring, early evaluation and intervention, engagement with simulation based team training, advancements in technology, learning from safety incidents and positive patient pathways should be used to re-enforce safety. Regional anesthesia-based nontechnical skills (cognitive, social, and personal resource skills that complement technical skills) contribute to safe and efficient task performance and are also important in improving patient experience. The most practical safety approach is multidisciplinary, which keeps clinical judgment and patient-centric decision-making at its core. A literature search was done using the library search engine called discovery, which accesses Ovid, open access, evidence-based medicine, and nursing databases. Individual complications were also searched, and appropriate secondary citations were used accordingly.

Keywords

• human factors
• local anesthetic toxicity
• nerve injury
• patient safety
• simulation
• stop before you block
• ultrasound