Regional anaesthesia and side effects: is it safe?

The availability of new local anaesthetics and the improvement of regional techniques has caused a great increase of central and peripheral blockades for anaesthesia as well as for postoperative pain. The increase of these blockades tends to increase the rate of complications. In a Pubmed research we found more than 400 articles about this topic. In the analysis of the literature we divided two major chapters: severe complications after central blockades and after peripheral nerve blocks. Analysis of the literature showed a lower incidence of serious complications associated with neuroaxial anaesthesia. It is important to underline that authors stressed the importance of predisposing factors like pre-existing peripheral or central neurological disease, arteriosclerotic disease, osteoporosis and spinal stenosis, diabetes, cancer, chronic alcohol abuse and steroid therapy. Otherwise, the most concern about peripheral nerve blocks is nerve injury and/or neuropathy due to potential toxicity of local anaesthetics or due a nerve lesion for needle trauma or infection. Even if the incidence of severe side effects is rare, it is very important that we approach this technique knowing well the risks (even if low) so that we can prevent them improving the outcome of patients. Nevertheless, there is again the need to have a large prospective study to investigate the real incidence of severe complications of central and peripheral blocks.