With the ever-growing number of older persons that need joint replacements and the never-ending orthopedic trauma of the entire population, the practice of regional anesthesia is a growing wave of the future. Regional anesthesia, however, is not without risks or complications. This chapter discusses these risks and and how to manage them.

Whenever the integrity of the integument is violated, the risk of introducing infection is present, and, when a foreign body (like a peripheral nerve catheter) is left in situ, that increases the risk by maintaining a conduit for skin flora to bypass the protective barriers of the skin. Further, the location of the regional technique is important as an epidural abscess or spinal meningitis can cause significant morbidity or mortality. Infection localized to the insertion site would contaminate the needle as it passes through, allowing direct access of the microorganisms to the nerve plexus. Finally, systemic infection or bacteremia can allow infection to be spread hematogenously to the foreign body.

The anatomic locations where many peripheral nerves are blocked contain major blood vessels (for example, axillary, infraclavicular, supraclavicular, femoral, popliteal fossa, and sciatic). Many are deep locations at which applying direct pressure would be difficult or impossible (for example, epidural, spinal, classic paravertebral, infraclavicular, supraclavicular, lumbar plexus). Because the epidural space has an extensive venous plexus, bleeding can easily be caused by epidural or spinal anesthesia, inducing an expanding hematoma in a fixed and enclosed space that would cause spinal cord compression and paralysis.