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This paper aims to review common sympathetic nerve blocks to treat visceral pain. Extensive reviews exist exploring the approach to care for those with visceral pain due to malignancy. These often include interventional pain procedures. Research demonstrates these procedures may reduce opioid use. Research is ongoing to assess the efficacy when treating non-malignant source of visceral pain. Recently, several case reports and small-scale studies demonstrate benefits for non-painful entities, such as improved cardiac function after such procedures. The management of visceral algesia is complex. The approach to visceral pain should recognize the benefit of early discussions for the use of sympathetic blocks. Additionally, since most procedures have multiple techniques, analgesia can be achieved even in the setting of distorted anatomy due to tumor mass effects or post-radiation fibrosis, among other etiologies.

OBJECTIVES The purpose of this study was to identify the incidence of anesthetic errors per discharges in the United States within these errors, the incidence of death. A secondary aim was to identify any association between the mortality and patient comorbidities. METHODS A retrospective analysis of the hospitals in the United States using the Nationwide Inpatient Sample (NIS) database during 2007-2014 was performed. The study population consisted of patients who were recorded as inpatient discharges who experienced complications as a result of incorrect anesthetic administration resulting from either an overdose or inappropriate medication administration in the United States. RESULTS Between 2007 and 2014, a total of 17,116 anesthetic errors were reported. There was a substantial decrease in the total number of these errors over time, from 2483 in 2007 to 1391 in 2014 (44% decrease). There were 131 reported deaths in this cohort (0.77% mortality rate), with 61 mortalities in teaching hospitals (0.86% mortality rate) and 57 in nonteaching hospitals (0.73% mortality rate). During the study period, deaths decreased from 21 in 2007 (0.85% mortality rate) to 11 in 2014 (0.79% mortality rate), corresponding with a 7.1% decrease in the mortality rate. Comorbidities associated with a significant increase in mortality from anesthetic substances included fluid and electrolyte disorders (odds ratio 8.82, 95% confidence interval 5.24-14.83, P < 0.001) and coagulopathies (odds ratio 5.26, 95% confidence interval 2.53-10.93, P < 0.001). CONCLUSIONS Our study showed that although the incidence of anesthetic errors is small, they do still exist in our hospitals. Certain comorbidities appear to predispose patients to increased risk. The subsets of patients who appear to be at the greatest risk include those with preexisting electrolyte and fluid disorders and coagulopathies.