Non-adherence to Clinical Practice Guidelines in Regional Anesthesia and Pain Interventions: Insights From a Comprehensive Case Series Review

Adhering to established guidelines, regional anesthesia (RA) and pain interventions are essential for preventing or minimizing the risk of complications. This study examines neurological complications that may arise when RA or pain interventions are performed without adherence to the clinical practice guidelines. This article aimed to emphasize the relationship between deviations from standards of care in RA and neurological outcomes. Specifically, it focuses on neurological deficits associated with RA and pain interventions. This retrospective study analyzed five cases, selected from 18 cases meeting the inclusion criteria, reviewed over a period from 2012 to 2023. The data collected included patient demographics, anesthesia details, neurological deficits, diagnostic findings, management approaches, and outcomes at three- to six-month follow-ups. The article presents five cases, each examining the techniques used, clinical diagnosis, radiological imaging, neurophysiological studies, and the management protocols involved. Furthermore, it highlights the consequences of deviations from the standard of care and their impacts on neurological outcomes. Outcomes and key lessons learned from each case are discussed. Five cases were analyzed, revealing deviations from the standard of care such as incorrect spinal needle placement, injection despite warning signs, inadequate patient evaluation, and procedures performed by inexperienced anesthetists. While some patients achieved full recovery, others experienced lasting deficits. The study emphasizes the critical importance of strict adherence to clinical practice guidelines in RA and pain interventions to minimize neurological complications. It highlights the essential roles of proper training, precise technique, thorough patient evaluation, patient-centered care, informed consent, and the use of advanced diagnostic tools to mitigate risks and improve patient safety and outcomes.