Providence St. Peter Hospital
Anesthesia Department

November 4, 2009

Use of the Patient Warning Instructions for Period following Regional Anesthesia

Regional nerve blocks are increasingly used to control post-operative pain in surgical patients having procedures involving the arm or leg. Most regional blocks cause a loss of sensation and motor control in the blocked extremity. Both of these conditions can constitute a hazardous situation for the patient for the duration of the block.

The patient with a nerve block of the leg is prone to falling because the loss of muscle control can interfere with balance and holding the leg in extension. The loss of sensation and proprioception can prevent the patient from sensing off balance positions and reacting to them. Any extremity with a nerve block, arm or leg, is in danger of injury from malpositioning, sharp objects or thermal insult, because the patient is unaware of ongoing damage while the block is in place.

These are not theoretical problems. Patients are injured, all over the world, because nerve blocks are performed without giving the patients adequate warning and instruction.

For the above reasons, we are instituting a program to inform the patient with a nerve block of precautions that should be observed while the block is working.

We will be placing a clearly visible adhesive warning label directly on the patient dressing or bandage, and including a warning placard to be placed on the in-patient room door, or taken home by the out-patient.

Following the procedure outlined below;

1. The regional block takes place.

2. The anesthesia nurse fills out the adhesive label and placard with a date and time 24 hours from the time of the block.

3. The anesthesia nurse places the completed label and placard onto the front of the patient chart.

4. After the surgery is completed, the circulating nurse in the OR adheres the label to the outermost layer of the patient dressing or bandage so that it is visible.

5. The warning placard:
a. for in-patients, the placard is placed on the door of the patient room so that it is visible to visitors,
b. for out-patients, the placard is uppermost on the take-home materials.

6. It is intended that warnings on the labels and placards be followed until the effects of the nerve block dissipate, in other words, full feeling and movement return to the extremity. During the period of time that the nerve block is in effect, the warnings and instructions contained on the warning label take priority over any other instructions where they are in conflict.

7. The warning label and placard are to be discarded when the nerve blocks dissipates, in other words, full feeling and movement return to the extremity. The 24 hour date and time are an estimate of the actual duration.