Fewer Wrong-Site Peripheral Nerve Blocks Following Updates to Anesthesia Time-Out Policy.

Peripheral nerve block (PNB) has been shown to be safe and effective, and its use has continued to increase, but it is not without risks. One potentially preventable risk is wrong-site blocks (WSBs). Our institution mandated a time-out process before PNB in 2003, and then in 2007 made two more changes to our policy to mitigate risk: (1) the circulating/block nurse was the only person permitted to access the block needles; after a time-out period was complete, the nurse gave the needles to the anesthesiologist; and (2) the nurse remained at the patient's bedside until the PNB was initiated.

Post-Dural Puncture Headache is Uncommon in Young Ambulatory Surgery Patients.

Background: The incidence of post-dural puncture headache (PDPH) arising from spinal anesthesia in the general population is low. However, patients under 45 years have been shown to exhibit a higher incidence of PDPH, even with small needles.

Questions/purposes: This study aimed to estimate the incidence of PDPH from a 27G pencil-point needle in ambulatory surgery patients between the ages of 15-45 years and compare incidence of PDPH by age group, sex, and history of headache.

Stroke, regional anesthesia in the sitting position, and hypotension: a review of 4169 ambulatory surgery patients.

Background And Objective: Intraoperative hypotension is used to reduce surgical bleeding. Case reports of stroke after general anesthesia in the sitting position led us to collect data (patient demographics, medical risk factors for stroke, intraoperative hemodynamics) about the incidence of stroke after surgery in the sitting position.

Methods: This study reviewed 4169 (3000 retrospective, 1169 prospective) ambulatory shoulder surgeries in the sitting position.

One-year experience with day-of-surgery pregnancy testing before elective orthopedic procedures.

Background: Elective surgery is generally postponed in pregnancy. A policy of testing for urine human chorionic gonadotropin (hCG) in all women of childbearing age on the day of surgery was initiated at an elective orthopedic surgery facility. This is a retrospective report of our 1 yr experience and the associated costs.

A new approach to preanesthetic site verification after 2 cases of wrong site peripheral nerve blocks.

Objective: We discuss the importance of a "preanesthetic site verification" and highlight 2 significant modifications to a policy developed at our institution in 2003.

Case Report: The report describes 2 cases of wrong site peripheral nerve blocks that initiated protocol amendments to address shortcomings of the original policy. Two specific limitations were identified to improve upon.

Two cases of a wrong-site peripheral nerve block and a process to prevent this complication.

Objective: The purpose of this study was to develop a system to prevent laterality errors while performing peripheral nerve blockade.

Case Report: The report depicts 2 cases of peripheral nerve blocks being performed on the wrong (nonoperative) extremity. An analysis of the circumstances in each case reveals distractions, schedule changes, and communication breakdown, which contributed to the error.