Wrong side anesthesia (regional blockade of the incorrect site) has been reported to the VHA National Center for Patient Safety and constitutes a significant fraction of wrong-site procedures in several other databases. 

While the consequences of wrong-site anesthesia are generally not as severe as wrong-site surgery, this is still an unnecessary risk and unnecessary procedure that can be avoided with proper precautions.

Based on that, we recommend that each facility consider including in its anesthesia operating policies a provision that prior to performing a regional blockade that has laterality (right or left arm, leg, fingers, etc), one of two paths should be followed:

1.  If the surgeon has already marked the site, then the anesthesia provider performing the block ensures that the surgeon’s mark agrees with the consent and that the mark will be visible when the block is performed.  If the surgical site mark will not be visible after prepping and draping then the anesthesia provider is to mark the intended block site to maintain reference to appropriate laterality (e.g. the mark of the surgeon on the foot would not suffice during performance of a sciatic nerve block at the level of the buttock since it would no be visible after draping).
2.  If the surgeon has not yet marked the site, then two qualified staff confirm the laterality of the procedure with the consent form.  The anesthesia provider is always one of the staff.  The other staff person must not be a member of the team performing the block.     

The “mini time-out” is documented as part of the anesthesia record for the nerve block.

Follow this link to download a sample policy  that you can adapt for your facility.

When adapting the sample consider whether surgeon marking of the surgical site should always be done before this pre-regional blockade verification process.  That might be local practice in your area.