Practice advisory on the bleeding risks for peripheral nerve and interfascial blockade: going out on a limb

Excerpt

Although rare, neuraxial hematoma, because of the catastrophic nature of bleeding into a relatively fixed and non-compressible space, is the most significant hemorrhagic complication of regional anesthesia. Efforts to define risk factors, patient management (especially in the presence of antithrombotic therapy), and other processes to facilitate diagnosis and optimize outcomes have been the focus of evidence-based guidelines.1,2 The risk of significant bleeding complications during plexus, interfascial plane, and peripheral nerve block techniques is also rare, especially in the absence of antithrombotic therapy. Nevertheless, hemorrhagic complications following the deep plexus/deep peripheral techniques (e.g., lumbar sympathetic, lumbar plexus, and paravertebral blocks), particularly in the presence of antithrombotic therapy, are often serious and a source of major patient morbidity, including death from massive bleeding. Indeed, cases of clinically relevant bleeding associated with non-neuraxial techniques often present with signs and symptoms of significant blood loss rather than neurologic deficits.1 …