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Our nerve injury solicitors offer free advice on all matters relating to negligent medical treatment including nerve injuries caused by medical negligence. If you would like free advice on negligent nerve injury compensation claims, with no further obligation, just use the helpline or complete the contract form or email our offices and a specialist medical negligence solicitor will discuss your potential compensation claim over the telephone and tell you how best to proceed to protect your right to claim compensation for personal injury caused by a negligent doctor. Our nerve injury solicitors will give their best opinion on liability and will value the compensation payable on the available medical evidence. It is in your best interest to speak to a nerve injury solicitor as soon as possible after the negligent event - time limits apply.

Negligent Nerve Injuries

Negligence can come in many areas of medicine. Negligent incidents can cause nerve injuries that may be temporary or permanent. Even the temporary nerve injuries can cause pain, numbness and suffering, that often lasts for several months or in some cases years. Nerve injuries can be classified as peripheral nerve injuries or central nerve injuries, such as injuries to the spinal cord during spinal surgery or epidural surgery.

Accidental nerve damage can be caused in many ways :-

  • insufficient blood supply causing oxygen starvation to the nerves
  • excessive physical traction
  • excessive force used to deliver a baby leading to an injury in the brachial plexus
  • improper administration of anti blood clotting drugs
  • inadvertent injection of certain drugs into or around the surrounding area of a nerve
  • administration of certain toxic drugs
  • direct physical damage due to the different procedures including cutting, burning, stretching or compression
  • direct compression to a nerve due to application of a tourniquet
  • blood pressure build up in the vicinity of a nerve due to a damaged blood vessel.
  • unwarranted nerve pressure due to improper positioning of the body during a surgical operation

Peripheral Nerve Injuries

Medical negligence claims involving anaesthesia arise from nerve injury to the ulnar nerve and represent about a third of all nerve damage compensation claims. This can involve direct injury to the nerve from a misplaced venepuncture or from attempting a nerve block involving a hypodermic needle and accidentally causing mechanical injury to the nerve.

Peripheral nerves, such as the ulnar nerve are actually quite complex structures. They consist of nerve fibres surrounded by endoneurium, which is a connective tissue sheath. These sheaths are held together by perineurium, which surrounds the endoneurium. The connective tissue that holds the entire nerve together is called the epineurium. In order for the nerve to function, it must be surrounded by these connective tissue structures. Blood vessels enrich the nerve by perforating the epineurial and endoneurial tissue. The tiny capillaries that enrich the nerve are separated from the external tissue by the functional equivalent to the 'blood brain' barrier.

A traumatic nerve block or errant venepuncture can disrupt the milieu in which the nerve functions and can result in a permanent or temporary neuronal functional loss. Things that can damage the nerve include mechanical disruption of the nerve, needle trauma to the nerve, injecting a substance directly into the nerve, cutting off the blood flow to the nerve, the use of neurotoxic local aesthetics in the vicinity of the nerve, a drug interaction, or infection in the nerve. Most cases of nerve disruption happen as a result of multiple factors occurring at the same time.

Nerve impairment following the intraneural injection of a substance into the nerve can cause mild or no damage to degeneration of the myelin, which severely injures the capacity of the nerve to function. It all depends on what was injected into the nerve. On the other hand, some studies have shown that, when intrafasicular injection of a substance into the nerve has occurred, the damage is generally severe.

It is recommended that, during a nerve block, the anaesthesiologist should use some method of determining whether or not the nerve is functioning during the application of the block. The doctor could ask the patient about any paraesthesia he or she feels when applying the block or can stimulate the nerve to assess its function while applying the block. Failure to do so could result in unnecessary nerve trauma and is considered to be medical negligence.

Some texts indicate that if the patient experiences lancinating pain when the needle is injected or if the doctor uses too much pressure when injecting the local aesthetic, this can indicate the probability of peripheral nerve injury and should cause the doctor to rethink where the needle is being positioned and the pressure used to place the aesthetic. Failure to do so can result in a compensation claim for medical negligence.

Patients who are under excessive sedation at the time of their aesthetic are unable to tell the doctor whether or not there is pain at the site of the injection. This could mean that a nerve block could be placed in a place that not only numbs the nerve but permanently paralyzes it. For this reason, it is not recommended to place a nerve block in a sedated patient.

Most damage to nerves comes as a result of using high pressure when injecting the drug or aesthetic. For this reason, the injections should be as slow as is feasibly possible so as not to damage the peripheral nerve nearby. Even if the nerve is punctured, the individual fascicles can be spared if the injection pressure is low.

Another risk to peripheral nerves is that the blood supply to the nerves is affected by the injection. If the injection coagulates the blood within the arteries or capillaries that supply the nerve fascicles themselves, then the blood supply to the nerve is impaired/impairing the nerve function as well. Haematoma or blood clots in the intrafasicular area can block adequate blood supply to the nerve, causing a nerve injury that can be permanent.

Finally, the nerve can be bathed in local aesthetic that backs up into the central nervous system, resulting in a central nerve block. This can cause paralysis anywhere from the cervical area to the lumbar area; however, such paralysis to this degree are usually temporary.

Many doctors are turning to nerve stimulators as ways to inject anaesthesia during nerve blocks. These are better because they don't rely on the patient's perception of a paraesthesia in order to know that a nerve block is with the nerve bundle or too close to a nerve. The nerve stimulator is used to identify the function of the nerve in order to assure that the nerve is viable as the injection is being placed. In some locations, failing to use a nerve stimulator to determine peripheral nerve block placement constitutes negligence. While nerve damage can occur when using a nerve stimulator, it is considered much less likely. Older models of nerve stimulators may actually give a false sense of security to the doctor.

It should be noted that all local aesthetics have the potential for neurotoxicity, especially when given in high doses and over a short period of time. The more potent and more concentrated the aesthetic, the higher is the risk of damage to the nerves. The amount of exposure the nerve has to the aesthetic also plays a role in who gets permanent nerve damage and who doesn't. If the injection of aesthetic is within the fascicles, the drug gets concentrated there and doesn't flow through the interstitial tissue. This increases the damage to the nerve.

Special care must be given to use strict aseptic technique to avoid local infection that can seriously debilitate a patient, to use insulated short-bevelled needles, which prevent nerve penetration and to know which needle is appropriate for which kind of block. The needle should be advanced slowly, using the nerve stimulator to tell the location of the nerve. Forceful or fast injections should be avoided. If the patient experiences paraesthesia, then the doctor should reposition the needle until the paraesthesia is not felt.

Spinal Injuries

Spinal injuries as a result of spinal aesthetic occur in about one in 10,000 procedures and the incidence of spinal injuries following epidural anaesthesia is about 1 in 11,000. The epidurals used in the study were done for caesarean sections in otherwise healthy women. The rate of epidural injury in another study was zero injuries in 20,000 caesarean section epidurals.

The most common injury noted was believed to be due to needles contaminated by detergents or other toxic drugs that were injected along with the aesthetic, resulting in a condition called ascending arachnoiditis. Other rare complications of an epidural aesthetic are bacterial meningitis, an epidural abscess and damage to the spinal cord itself. These are very uncommon side effects; however, the results can be devastating. Failing to use proper aseptic technique or damaging the spinal cord are things that can be remedied and constitute negligence if they occur. Accidental injection of aesthetic into the patient's vascular system can occur even when pulling back on the hypodermic needle plunger and can cause patient toxicity.

Negligence in Nerve Blocking

If the spinal cord is damaged as a result of a botched epidural or spinal aesthetic administration, the patient can have permanent paralysis of the lumbar spinal nerves. In its extreme form, it can cause paraplegia or death due to bacterial meningitis which has failed to be recognized and possibly treated.

With peripheral nerve injury, the patient could suffer from nerve damage that affects both motor and sensory aspects of nerve function. The patient could be unable to move certain fingers or could have anaesthesia or chronic paraesthesia of an extremity, usually the upper extremity, which is the site of most peripheral nerve blocks.

When such an injury occurs, the legal team supporting the patient must show that negligence occurred in the case by reading the medical records, interviewing the patient and any eyewitnesses to the nerve block and by studying the examinations of experts who have done nerve conduction studies showing damage to the affected nerves.

The legal team must also assess the limitations in function the patient now experiences because of nerve damage. If the damage is purely paraesthesia or anaesthesia, it pays to recognize what effect this has on the patient�s life. Can the patient still do activities of daily living? How are activities of daily living impaired? How are hobbies impaired by the loss of nerve function? If the patient has motor loss, how does this impact his or her enjoyment of life? Is there pain and suffering involved?



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The author of the substantive medical writing on this website is Dr. Christine Traxler MD whose biography can be read here