Nerve injury associated with anesthesia - A closed claims analysis

Background: Nerve injury associated with anesthesia is a significant source of morbidity for patients and liability for anesthesiologists. To identify recurrent and emerging patterns of injury we analyzed the current American Society of Anesthesiologists (ASA) Closed Claims Project Database and perf ormed an In-depth analysis of claims for nerve injury that were entered int o the database since the authors' initial report of the subject. Methods: The ASA Closed Claims Database is a standardized collection of cas e summaries derived from the closed claims files of professional liability insurance companies. Claims for nerve Injury that were not included in the authors' 1990 report were reviewed in-depth. Results: Sh hundred seventy (16% of 4,183) claims mere for anesthesia-relat ed nerve injury. The most frequent sites of injury were the ulnar nerve (28 %), brachial plexus (20%), lumbosacral nerve root (16%), and spinal cord (1 3%). Ulnar nerve (85%) injuries were more likely to have occurred in associ ation with general anesthesia, whereas spinal cord (58%) and lumbosacral ne rve root (92%) injuries were more likely to occur with regional techniques. Ulnar nerve injury occurred predominately in men (75%) and was also more a pt to have a delayed onset of symptoms (62%) than other nerve injuries. Spi nal cord injuries were the leading cause of claims for nerve injury that oc curred in the 1990s, Conclusion: New strategies for prevention of nerve damage cannot be recomme nded at this time because the mechanism for most injuries, particularly tho se of the ulnar nerve, is not apparent.