Nerve Block and Injection Nerve Injury Claims

Nerve blocks and injections linked to nerve injury

A nerve block is essentially a chemical barrier created by injecting an anaesthetic near specific nerves. This stops pain signals from travelling from that part of the body to the brain. While the vast majority of these are performed safely, errors in technique, judgment, or equipment use can lead to serious injury.

Peripheral nerve blocks (upper limb and lower limb blocks)

Peripheral nerve blocks are frequently used for surgeries on the arms, hands, legs, or feet. Instead of putting you completely to sleep with general anaesthesia, the anaesthetist numbs only the limb being operated on.

For example, an interscalene block (in the neck) might be used for shoulder surgery, or a femoral block (in the groin) for knee surgery. The aim is to make the arm or leg completely numb and heavy. However, if the needle is placed too close and damages the nerve bundle, it can affect movement and feeling in the arm or leg permanently. This type of peripheral nerve block complication can make it difficult for a person to return to manual work, drive a car, or even perform simple tasks like holding a cup or walking without a stick.

Spinal and epidural injections (including during childbirth and surgery)

These are known as "central" nerve blocks because they target the nerves right as they leave the spinal cord. They are used to numb the entire lower half of the body.

You are likely familiar with these in the context of maternity care (epidurals for labour pain) or for surgeries like hip replacements, knee replacements, or caesarean sections (spinals). Because these needles are placed into the back, very close to the spinal cord and major nerve roots, extreme care is required. Epidural nerve injury or spinal block nerve damage can result in very serious complications. These can range from a patch of numb skin on the leg to severe weakness, difficulty walking, or even permanent problems with bladder and bowel control.

Pain management injections

Pain clinics play a vital role in treating people with chronic back, neck, or joint pain. Doctors often use targeted injections to deliver strong anti-inflammatory steroids or local anaesthetic directly to the source of the pain.

Common procedures include epidural steroid injections (placing steroids around the spinal nerves) or facet joint injections (targeting the small joints in the spine). While the intention is to reduce swelling and pain, injecting these powerful medicines into the wrong area,or accidentally damaging a blood vessel near the nerve,can worsen the patient's condition significantly.

Dental local anaesthetic blocks

Almost everyone has had a "freezing" injection at the dentist. While usually temporary, dental nerve block injury is a real risk.

This happens if the needle strikes the nerves that supply the tongue (lingual nerve) or the lower jaw (inferior alveolar nerve). If damaged, the patient may be left with a permanently numb tongue, a loss of taste, or a burning, tingling sensation in the chin and lip area. This can be incredibly distressing, affecting how a person speaks, eats, and drinks. It can lead to biting the lip or tongue unknowingly and can cause significant psychological distress.

Other injections that can cause nerve injury

It is not just specialist anaesthetists who perform injections. Nurses and doctors perform intramuscular (IM) injections (like vaccinations, antibiotics, or anti-sickness medication) and insert cannulas (drips) every day in hospitals and GP surgeries.

If an IM injection is placed in the wrong spot,for example, hitting the large sciatic nerve in the buttocks or the radial nerve in the arm,it can cause immediate and sometimes permanent damage.

How nerve injury can happen after a nerve block or injection

Nerves are fragile structures. You can think of them like the electrical cables that carry messages between your brain and your body. If the "casing" of the cable is damaged, or the wires inside are cut or crushed, the signal fails or goes haywire.

In cases involving injections, the damage usually stems from one of the following issues:

• Direct needle trauma and injection into the nerve: This is the most direct cause of injury. It happens when the needle physically pierces or cuts the nerve itself. If the doctor then pushes the plunger and injects fluid inside the nerve bundle (rather than around it), the pressure can build up instantly. This internal pressure can rupture the tiny fibres inside the nerve, causing catastrophic damage from the inside out.
• Chemical irritation, concentration or medication errors: Nerves are very sensitive to chemicals. If the wrong type of fluid is injected, it can be toxic to the nerve. Similarly, if the anaesthetic is too strong (wrong concentration) and is placed right next to the nerve, it can chemically burn the tissue. This toxicity can cause the nerve to stop working or to send constant pain signals.
• Bleeding or haematoma causing compression: If a needle nicks a blood vessel next to a nerve, blood can leak out into the surrounding space. This forms a collection of blood, similar to a deep internal bruise (haematoma). As this pool of blood grows, it takes up space and presses hard against the nerve. If this pressure isn't relieved quickly, the nerve can be crushed.
• Infection, abscess, inflammation and delayed complications: If the skin isn't cleaned properly, or if the equipment isn't sterile, bacteria can be pushed deep into the body. This can lead to a deep infection or an abscess (a collection of pus). Just like a bleed, the swelling from an abscess presses on the nerve, cutting off its function. This is often a slower process, with pain and weakness appearing days after the procedure.
• Vascular injury and reduced blood supply: Nerves need a constant supply of blood to survive. If the injection damages the tiny arteries feeding the nerve, or if medication is accidentally injected into an artery and blocks it, the blood supply can be cut off. Without blood, the nerve tissue creates an "infarct",it effectively dies, just like heart muscle during a heart attack.
• Positioning and pressure during anaesthesia or recovery: Sometimes the injury is not from the needle itself, but from how the patient was positioned while they were numb. If a heavy limb is left hanging off a trolley, or pressed against a hard surface for hours while the patient cannot feel it, the nerve can be crushed by the patient's own body weight. This is a failure of nursing and medical care during the vulnerable period when the patient cannot protect themselves.

Symptoms of a nerve injury after an injection or nerve block

It can be very difficult for patients to know if what they are feeling is normal recovery or a sign of something serious.

What is usually normal at first:

Immediately after a local anaesthetic or block, it is expected that the area will feel heavy, numb, or weak. This is the intended effect of the medication. Depending on the type of block used, this can last anywhere from a few hours to 24 hours (or slightly longer for certain long-acting drugs). The limb may feel like "dead weight." However, as the anaesthetic wears off, sensation and movement should return to normal.

Signs that need prompt medical review:

If the numbness does not fade when it should, or if you experience worsening pain that feels different from surgical pain, you should seek advice. This pain is often described as burning, shooting, or like electric shocks. Progressive weakness (getting weaker rather than stronger) or spreading numbness that moves to new areas are also clear warning signs that something is wrong.

Red-flag symptoms (Medical emergency):

Certain symptoms are critical emergencies. If you have had a spinal or epidural injection and experience any of the following, you must go to an Emergency Department immediately:

• Bladder changes: Difficulty passing urine, or being unable to feel that your bladder is full.
• Saddle anaesthesia: Loss of sensation around the back passage, buttocks, or genitals.
• Bowel changes: Loss of bowel control.
• Rapidly worsening neurological symptoms: Severe back pain coupled with weakness in the legs that is getting worse quickly.

These are signs that a pool of blood or an abscess may be pressing on the spinal cord. If this pressure is not surgically removed within hours, the paralysis can become permanent.

What should be done (The standard of care)

Not every nerve injury is due to negligence. Some complications are recognised risks that can happen even in the best hands. However, for a claim to be viable, it must be shown that the care provided fell below the acceptable medical standard.

Pre-procedure assessment

Before any needle comes near you, the doctor should check your medical history thoroughly. This involves looking for reasons not to do the block. For example, if you are on blood-thinning medication (anticoagulants), poking a needle near the spine is very dangerous because it increases the risk of bleeding. They should also check for any existing infection or nerve problems.

Consent and communication of material risks

You must be told about the material risks. If there is a risk of permanent nerve damage, you should be informed of this so you can decide whether to go ahead or choose a different option (like a general anaesthetic). If you were not warned of a serious risk that then happened, there may be an issue with consent.

Correct site, technique and appropriate guidance

Blindly inserting needles is becoming less common for major blocks. The standard of care often requires the use of ultrasound guidance (to see the nerve and needle on a screen) or fluoroscopy (live X-ray guidance) to ensure accuracy. Using these tools incorrectly, or failing to use them when indicated, can be a breach of duty.

Sterile practice and medication handling

Strict sterility is non-negotiable. The skin must be cleaned properly, and the doctor must ensure the correct medication and dose are drawn up. Injecting the wrong fluid is a "never event",something that should simply not happen with proper checks.

Monitoring and post-procedure checks

Care does not end when the needle is removed. Medical staff must monitor the site and the patient’s recovery. If a patient complains of shooting pain during the injection, the procedure should stop or the needle should be repositioned immediately. Ignoring a patient's cry of pain during an injection is a common feature in peripheral nerve block complication cases.

Recognising and escalating complications without delay

If a complication does occur (like a bleed or infection), the standard of care requires that it is spotted and treated quickly. Delays in diagnosing a spinal haematoma or a deep infection can turn a treatable issue into a permanent disability.

How nerve injury claims are assessed in Ireland

In Ireland, to succeed in a clinical negligence Ireland claim, we generally need to establish four key elements:

1. Duty of Care: The medical professional owed you a duty of care (this is automatic in a doctor-patient relationship).
2. Breach of Duty: The doctor failed to meet the standard of care expected. This means proving they did something no other competent doctor would have done, or failed to do something an ordinary competent doctor would have done.
3. Causation: The breach of duty directly caused your injury. We must show that if the care had been correct, the nerve injury would not have happened (or would have been much less severe).
4. Damage: You have suffered actual harm (physical injury, psychological trauma, and financial loss) as a result.

Time limits and “date of knowledge” for nerve injury claims

The law in Ireland is very strict regarding time limits. This is governed by the Statute of Limitations.

Generally, you have two years to start a legal action. This clock usually starts ticking from the date the injury happened.

However, in medical cases, patients often do not know they have been injured due to negligence straight away. You might think the pain is just a normal part of recovery because the doctor told you so. This is where the "date of knowledge" is important. The two-year limit might not start until you actually found out (or should have found out) that the injury was significant and was caused by the medical treatment. Determining this date can be legally complex, so obtaining early advice is crucial.

Evidence that is commonly important in injection and nerve block cases

To prove a case, we need to gather facts. We handle this entire process for you, but it helps to know what we are looking for.

• Anaesthetic chart, procedure notes, drug charts and observation records: These are the most critical documents. We look at the anaesthetic chart to see exactly how the injection was done, what needle was used, and what drugs were injected. We check the observation records to see if your blood pressure dropped or if you complained of pain at the time.
• Consent forms and information provided before the procedure: We examine the paper trail to see if you signed a form that actually explained the specific risk that happened to you. If the form is blank or vague, it strengthens the argument that you were not properly warned.
• Imaging reports and referrals (neurology, pain clinic, orthopaedics): MRI scans, ultrasound reports, and nerve conduction studies (tests that check how well nerves work) are vital. They help us prove that the damage exists and show exactly where it is located.
• GP and hospital attendances after symptoms began: Notes from your GP or return visits to the hospital are important evidence. They show a timeline of your pain and prove that you complained of symptoms early on.
• Independent expert review and causation analysis: This is the cornerstone of any case. We send your records to an independent medical expert (usually a senior consultant anaesthetist or neurologist from the UK) to get an objective opinion on whether the care you received was up to standard.

Typical stages of a nerve injury case

1. Records: We take your detailed statement and request all your relevant medical records from the hospitals and GPs involved.
2. Expert Opinion: We instruct an independent expert to review the file. They will tell us if there was negligence and if that negligence caused your injury.
3. Formal Steps: If the expert report is supportive, we write a "Letter of Claim" to the other side, setting out the allegations.
4. Court Process: We help you formally sue the parties responsible. The vast majority of these cases are settled outside of court, but we prepare every case as if it is going to trial to ensure the best possible result for you.

Frequently Asked Questions

How long should a nerve block last?

It depends on the specific medicine used. Short-acting blocks might last 4,6 hours, while long-acting ones can last up to 24 hours. If you are still significantly numb or weak days later, this is not the normal effect of the drug and you should ask for a review.

Can nerve injury symptoms appear days after an injection?

Yes. While direct needle damage usually hurts immediately, injuries caused by compression (like a bleed or abscess) can take time to develop. Swelling can build up over hours or days, slowly crushing the nerve. If symptoms appear later, do not ignore them.

What if symptoms were dismissed as “normal”?

This is unfortunately common. Patients are often told their burning pain or weakness is "just post-op swelling" or "normal recovery." If you were told this, but it turned out to be a nerve injury, you may still have a case. The fact that you were reassured falsely might also help with the time limit (date of knowledge) arguments.

What records should I request, and how?

You have a legal right to your medical file under Freedom of Information acts or GDPR. However, when investigating a claim, your solicitor will usually request the full "legal set" of records for you. This ensures that nothing is missing, such as nursing notes or theatre logs, which can be missed in a standard patient request.

How long do I have to start a clinical negligence action?

According to the Law Society of Ireland, the general rule is two years from the date of the injury or the date you acquired knowledge of the injury. Because investigating these claims takes time (getting records and expert reports), it is best to act as soon as you suspect something is wrong.

What about children and time limits?

If a child suffers a nerve block nerve injury, the time limits are different. The two-year clock does not start ticking until they turn 18. This means they generally have until their 20th birthday to bring a claim.

Contact Michael Boylan LLP

If you or a family member has been left with lasting pain, weakness, or numbness after a medical injection, it can be incredibly helpful to speak with a solicitor who is experienced in medical negligence in Ireland. We can help you find out if the injury was just an unfortunate risk, or if it was caused by a preventable error.

Preparing for an initial discussion is simple. It helps to have a rough timeline of what happened: the date of the procedure, the name of the hospital or clinic, and when you first noticed that something was wrong. If you have any letters or discharge summaries, those are useful too, but do not worry if you don't have everything yet. We will guide you through the process of gathering what is needed.

Contact us to discuss your experience in confidence.

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