Significant hemorrhage associated with a regional nerve block is infrequent but can be serious.
Risk factors for hemorrhage:
(1) pre-existing coagulopathy
(2) anticoagulation
(3) type of the block
Serious hemorrhage can occur with:
(1) vertebral column hematoma: if there is cord compression, then it must be relieved within 8-12 hours or permanent neurologic injury can occur
(2) deep nerve block: hemorrhage may go undetected and is difficult to control
High risk block:
(1) deep cervical plexus
(2) lumbar plexus block
(3) quadratus lumborum block
(4) paravertebral block
Intermediate risk block:
(1) intrascalene brachial plexus block
(2) supraclavicular brachial plexus block
(3) infraclavicular brachial plexus block
(4) femoral nerve block
(5) suprainguinal fascia iliaca block
(6) obturator nerve block
(7) adductor canal nerve block
(8) proximal sciatic nerve block
(9) popliteal sciatic nerve block
(10) rectus sheath
(11) transversus abdominis block
(12) transverse abdominis subcostal block
(13) ilioinguinal/iliohypogastric nerve
(14) transverse fascia block
(15) pectoralis nerve
(16) serratus anterior plane block
(17) intercostal block
Low risk block:
(1) occipital nerve block
(2) superficial cervical plexus block
(3) axillary brachial plexus block
(4) median, radial or ulnar nerve block
(5) lateral femoral cutaneous nerve block
(6) infrainguinal fascia iliaca block
(7) erector spinae plane block
(8) ankle block
