New weakness, numbness, or pain after surgery raises several questions. When did the symptoms begin? Where was the injury localized? What was the patient's condition before the procedure? A useful review examines the anesthetic and surgical course together. ASRA's 2015 practice advisory considers surgical factors, preexisting neurologic disease, and several possible mechanisms of nerve injury; it does not treat a postoperative symptom as proof that a nerve block caused it. ASRA practice advisory

Records to assemble

  • Preoperative history and examination, including prior neurologic symptoms, spine disease, diabetes, and relevant consultations.
  • Anesthesia assessment, consent documentation, complete anesthetic record, and the separate block procedure note.
  • Available ultrasound images or other retained block documentation, medication administration records, and catheter or infusion records when relevant.
  • Operative report and positioning, padding, and tourniquet documentation.
  • Recovery-room and ward examinations, nursing notes, patient calls, and the first documentation of a new deficit.
  • Subsequent neurology assessments, imaging, electrodiagnostic reports, treatment records, and follow-up examinations.

The complete chart may contain information that is absent from a discharge summary. Where a record or image was not retained, identify the gap rather than assuming what it would show.

Questions that organize the review

Does the location and timing of the deficit fit the proposed mechanism? Are the findings consistent across examinations? What competing explanations require assessment? How were symptoms communicated, evaluated, and followed over time? Which conclusions are supported by objective findings, and which depend on an incomplete history?

These questions help define the scope of an expert review. They do not resolve causation or the standard of care on their own. ASRA states that its advisory does not define the standard of care, and the society currently marks the 2015 document as under review. Any retrospective assessment should consider the clinical circumstances and the information available at the time of care. ASRA advisory and limitations