INTRODUCTION: The development of the practice of Regional Anaesthesia (RA) exposes anaesthetists to a greater number of critical incidents. Data from the litterature are reassuring and show a very low incidence of complications which cause is not always related to the practice of RA.

MATERIAL AND METHODS: The aim of this study was to analyze the claim rate related to a complication that occurred after RA. We did a retrospective study of the closed claims reported to SHAM insurance (the first medical liability insurer in France) over a period of 6 years (2011 to 2016).

RESULTS: 73 cases (80 complications) were reported for this type of complications between 2011 and 2016, involving 58 women (mean 37 years old) and 15 men (mean 60 years old), of whitch 15% had an anxiety-depressive situation. The complication occurred in a general care hospital (n = 41), a university hospital (21), a private institution (9) or during private practice of health professionals (2). 
The average time between the facts and the declaration was 6 months and the average opening / closing time was 35 months. 40 cases (54%) were settled amicably, 21 (29%) by an CCC (Conciliation and Compensation Commission) and 12 (16%) by judicial procedure.
The relevant specialties were obstetrics (n=34), orthopaedic surgery (23), visceral surgery (6), ophthalmology (5), gynaecological surgery (2), urological (2) or thoracic (1) surgery. 
The RA was an epidural analgesia (n=36), spinal anaesthesia (13), femoral (5), axillary (5), sciatic (6) or interscalenic block (1), peri-bulbar (4), infiltration (2) or topical (1).
Complications were neurological injury (37), post-lumbar puncture (8), chronic pain (5), bleeding (5), failure of RA (6), psychological disorder (3), cardiac arrest (1), blindness (1), diplopia (1), fall (1) or multiple causes (5).
In the neurological injuries, neuropathic pain is reported in 60% of the cases at the time of the puncture, a deficit persists in 67% of cases during the assessment and no fault from the anaesthetist is retained  in 90% of cases. In 80% of cases, chronic pain is associated with neuraxial anaesthesia. In 7 cases, the patients complain a lack of information (rarely retained) while correctly given and plotted in files (85% of cases). The tables reports the types of complications according to the type of RA.


DISCUSSION: The analysis of this series shows that claims related to RA practice remain infrequent over the period and occur more in young women with an anxiety-depressive. It is the neuraxial anaesthesia that generated most claims. The technical fault is generally not retained. The practice of ultrasound-guided is seldom sought after by the expert. The failure of RA is also a common cause of claims.


07 / Complications after regional anaesthesia (RA): a closed claims analysis (SHAM insurance).