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O U T P AT I E N T S U R G E R Y M A G A Z I N E O N L I N E | J A N U A R Y 2 0 1 5
A
dminister a nerve block
to a patient under gen-
eral anesthesia? Not a
safe practice, say 89.8% of the
106 anesthesia providers we
polled, unlike the Wisconsin
anesthesiologist embroiled in a
deadly malpractice trial
(tinyurl.com/lyk2xn3) who says he prefers to give blocks to uncon-
scious patients because they don't flinch when he inserts the needle.
That may be true, but a lawsuit claims a man, 62, suffered a fatal heart
attack shortly after being administered an interscalene nerve block
while still under general anesthesia during rotator cuff surgery.
Because he was unconscious, the suit says, he was unable to report
the classic symptoms of an intravascular injection — ringing in the
ears, numbness and tingling around the mouth.
The patient's widow argued that her husband should have been
given the option to remain awake while the block was being done.
The trial against anesthesiologist Robert Corish, MD, was still ongoing
at the time of publication, but some anesthetists offered their own
verdicts.
"If one needs a patient to be under general anesthesia to do a
brachial plexus block, perhaps they should find a more talented
provider for that task," says Gregory Rendelman, CRNA, of the
Lebanon (Pa.) VA Medical Center.
In court, Dr. Corish insisted that he isn't alone — that the practice is
the standard of care for many of his colleagues. Yet only 2% of our
survey respondents prefer that patients be unconscious; another 8%
S U R G E O N S ' L O U N G E
Nerve Blocks on Unconscious Patients a Bad Idea
aWakE anD aWaRE
z Still reSPOnSiVe It's important, say providers, for
patients to be able to answer questions while being blocked.