Informed Consent for Nerve Blocks and Epidurals

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Informed Consent for Nerve Blocks and Epidurals

By Ivan Urits, MD – Board Certified in Anesthesiology and Pain MedicinePublished Sep 22, 2026

A nerve block or epidural is often added to an operation for pain control, or used in place of general anesthesia. Many patients meet the anesthesia team only minutes before the procedure, sometimes after they have already signed a surgical consent form. When a complication follows, a familiar question comes up: was the patient told about this risk, and did the patient agree to the block?

This article covers the medical side: which risks and alternatives are relevant to a given block, what a typical anesthesia consent discussion includes, and what the records do and do not show.

Why regional anesthesia consent is its own conversation

Consent for surgery and consent for anesthesia are related, but they are not the same thing. The surgeon explains the operation. The anesthesia clinician explains the anesthetic plan, which may include a peripheral nerve block, a spinal, an epidural, or a catheter left in place after surgery. Many facilities use a separate anesthesia consent form for this reason. Others include anesthesia language in a combined form. Either way, a review usually starts by identifying who discussed the block, when, and what was written down.

What a disclosure of regional anesthesia risks typically covers

The risks that are medically relevant depend on the block, the patient, and the operation. Common topics include:

Block failure or incomplete block, and the possibility of needing additional medication or general anesthesia.
Nerve injury, including the difference between short-lived numbness or tingling and lasting injury.
Bleeding and infection, which matter more for neuraxial techniques and for patients on blood thinners.
Local anesthetic systemic toxicity, a rare but serious drug reaction.
Block-specific risks, such as breathing effects from blocks near the diaphragm nerve, a punctured lung with some chest wall and upper extremity blocks, or headache after a spinal or epidural.
Practical effects, such as a numb or weak limb after surgery and the need to protect it, or fall risk after lower extremity blocks.
Alternatives, including general anesthesia alone, other pain-control approaches, or a different block.

Published risk estimates help frame which risks are common and which are rare. In a review of 32 studies, Brull and colleagues (Anesthesia & Analgesia, 2007) estimated neuropathy rates of about 3.78 per 10,000 after spinal anesthesia and 2.19 per 10,000 after epidural anesthesia. For peripheral blocks, the estimated rates were about 2.84 per 100 after interscalene blocks, 1.48 per 100 after axillary blocks, and 0.34 per 100 after femoral blocks. The authors concluded that permanent neurologic injury after regional anesthesia is rare. Figures like these are often what a clinician has in mind when describing a risk as "uncommon" or "rare."

How consent is documented

In practice, consent documentation for a block may appear in several places:

a signed anesthesia consent form, with or without block-specific language;
a preoperative anesthesia evaluation note that mentions the discussion;
the block procedure note, which may record that risks, benefits, and alternatives were discussed;
a time-out record confirming the procedure, side, and site; and
for labor epidurals, a note written during labor, sometimes while the patient was in significant pain.

A standard form alone may not show which risks were discussed in words. A detailed note may fill that gap. A missing or unsigned form does not by itself show that no discussion took place.

What consent questions often turn on medically

From a medical point of view, consent questions in regional anesthesia cases often center on:

Was the specific block discussed? A general consent for "anesthesia" may or may not mention a nerve block, a catheter, or the side and site.
Was the injury one that is typically disclosed? Common or serious risks of the chosen block are the usual focus.
Was the patient able to take part? Sedation, pain, language barriers, and timing can all affect the discussion. Whether an interpreter was used is often documented.
Did the plan change? If a different block or technique was used than the one discussed, the record should explain why.
Were alternatives realistic? For some patients and operations, general anesthesia carries its own risks. The medical comparison is part of the picture.

Consent problems also matter in interventional pain procedures. In a pilot analysis of 82 interventional pain malpractice cases, Kamath and colleagues (Pain Physician, 2020), a study Dr. Urits co-authored, reported that procedural error was the leading reason claims were brought, followed by lack of informed consent and an unnecessary procedure being performed.

Records that usually matter

Surgical and anesthesia consent forms, including any block-specific forms
The preoperative anesthesia evaluation
The block or neuraxial procedure note and time-out documentation
Interpreter records, and nursing notes describing the patient's condition before the block
Medication records showing any sedation given before the discussion or the block
Patient education materials the facility used on the date of care

The published background behind this review

Dr. Urits co-authored Upper extremity regional anesthesia techniques: A comprehensive review for clinical anesthesiologists (Jones and colleagues, 2020), which covers the anatomy, techniques, and potential complications of upper extremity blocks. He was first author of Truncal regional nerve blocks in clinical anesthesia practice (2019), which covers the techniques, indications, and complications of chest wall, abdominal, and paraspinal blocks. His opinions rest on the complete record, the peer-reviewed literature, and generally accepted methodology.

Key takeaways

Consent for a nerve block or epidural is often separate from surgical consent, and the record may be spread across several documents.
The medically relevant risks depend on the specific block, the patient, and the operation.
Published risk estimates help explain which risks are common and which are rare.
Patients should be able to take part in the discussion, and the record should show what was discussed.

References

Brull R, McCartney CJ, Chan VW, El-Beheiry H. Neurological complications after regional anesthesia: contemporary estimates of risk. Anesth Analg. 2007;104(4):965-974. Abstract: https://pubmed.ncbi.nlm.nih.gov/17377115/
Kamath D, McIntyre S, Byerly S, et al. Descriptive Analysis of Federal and State Interventional Pain Malpractice Litigation in the United States: A Pilot Investigation. Pain Physician. 2020;23(4):413-422. Abstract: https://pubmed.ncbi.nlm.nih.gov/32709176/
Jones MR, Novitch MB, Sen S, ..., Urits I, Cornett EM, Kaye AD. Upper extremity regional anesthesia techniques: A comprehensive review for clinical anesthesiologists. Best Pract Res Clin Anaesthesiol. 2020;34(1):e13-e29. Abstract: https://pubmed.ncbi.nlm.nih.gov/32334792/
Urits I, Ostling PS, Novitch MB, et al. Truncal regional nerve blocks in clinical anesthesia practice. Best Pract Res Clin Anaesthesiol. 2019;33(4):559-571. Abstract: https://pubmed.ncbi.nlm.nih.gov/31791571/

Related: Informed Consent Cases

Educational information only. Not legal or medical advice.

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