Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1016/j.bjane.2021.02.043
Brazilian Journal of Anesthesiology
Systematic Review

Identification and economic burden of main adverse events of nerve injuries caused by regional anesthesia: a systematic review

Identificação e carga econômica dos principais eventos adversos das lesões nervosas causadas pela anestesia regional: uma revisão sistemática

Stefano Calciolari, Laura Guadalupe Gonzalez-Ortiz, Francesco ´ Mongelli, Laura Cantini, Xavier Capdevila, Davide La Regina, Andrea Saporito

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Abstract

Background and objectives
Anesthesiologists and hospitals are increasingly confronted with costs associated with the complications of Peripheral Nerve Blocks (PNB) procedures. The objective of our study was to identify the incidence of the main adverse events associated with regional anesthesia, particularly during anesthetic PNB, and to evaluate the associated healthcare- and social costs.

Methods
According to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we conducted a systematic search on EMBASE and PubMed with the following search strategy: (“regional anesthesia” OR “nerve block”) AND (“complications” OR “nerve lesion” OR “nerve damage” OR “nerve injury”). Studies on patients undergoing a regional anesthesia procedure other than spinal or epidural were included. Targeted data of the selected studies were extracted and further analyzed.

Results
Literature search revealed 487 articles, 21 of which met the criteria to be included in our analysis. Ten of them were included in the qualitative and 11 articles in the quantitative synthesis. The analysis of costs included data from four studies and 2,034 claims over 51,242 cases. The median claim consisted in 39,524 dollars in the United States and 22,750 pounds in the United Kingdom. The analysis of incidence included data from seven studies involving 424,169 patients with an overall estimated incidence of 137/10,000.

Conclusions
Despite limitations, we proposed a simple model of cost calculation. We found that, despite the relatively low incidence of adverse events following PNB, their associated costs were relevant and should be carefully considered by healthcare managers and decision makers.

Keywords

Complications,  Costs,  Nerve injury,  Regional anesthesia,  Complaints

Resumo

Introdução

Anestesiologistas e hospitais são cada vez mais confrontados com os custos associados às complicações dos procedimentos de Bloqueio de Nervos Periféricos (BNP). O objetivo do nosso estudo foi identificar a incidência dos principais eventos adversos associados à anestesia regional, particularmente durante o BNP anestésico, e avaliar os custos sociais e de saúde associados.

Métodos

De acordo com as diretrizes Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), realizamos uma busca sistemática no EMBASE e no PubMed com a seguinte estratégia de busca: (“regional anesthesia” OR “nerve block”) AND (“complications” OR “nerve lesion” OR “nerve damage” OR “nerve injury”). Estudos em pacientes submetidos a um procedimento de anestesia regional que não seja raquidiano ou epidural foram incluídos. Os dados direcionados dos estudos selecionados foram extraídos e posteriormente analisados.

Resultados

A busca na literatura revelou 487 artigos, 21 dos quais preencheram os critérios para serem incluídos em nossa análise. Dez deles foram incluídos na síntese qualitativa e 11 artigos na síntese quantitativa. A análise de custos incluiu dados de quatro estudos e 2.034 sinistros em 51.242 casos. A reivindicação média consistia em 39.524 dólares nos Estados Unidos e 22.750 libras no Reino Unido. A análise da incidência incluiu dados de sete estudos envolvendo 424.169 pacientes com uma incidência geral estimada de 137/10.000.

Conclusões

Apesar das limitações, propusemos um modelo simples de cálculo de custos. Constatamos que, apesar da incidência relativamente baixa de eventos adversos pós-BNP, seus custos associados foram relevantes e devem ser cuidadosamente considerados pelos gestores de saúde e tomadores de decisão.

Palavras-chave

Complicações, Custos, Lesão nervosa, Anestesia regional, Queixas

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Submitted date:
06/27/2020

Accepted date:
02/06/2021

6074983fa953955f69460495 rba Articles
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