‘My block doesn’t work’ - analysis of possible reasons, avoidance and emergency strategies

No clinician or technique can sustain a 100% success rate due to the many variables that exist between the patient, clinician and the environment. Success in regional anaesthesia is itself a variable, do you measure operative anaesthesia, operative analgesia or just postoperative analgesia? In clinical terms most anaesthetists would accept success of a regional technique as ‘that which avoids the need for general anaesthesia’. Whatever your end-point is, regional anaesthesia has an inherent failure rate; what’s important is whether your failure rate is acceptable and what strategies you should employ to minimise failure and how to deal with it.