<p>Postoperative Thoracic Epidural Analgesia: Adverse Events from a Single-Center Series of 3126 Patients</p>

Abstract

Purpose Thoracic epidural analgesia (TEA) has been shown to reduce postsurgical morbidity and mortality; nevertheless, major and minor complications can occur. We report our 10-year experience with TEA and incidence of complications. Patients and Methods Patients received continuous infusion TEA (0.2% ropivacaine and 2 µg ml −1 fentanyl) to control postoperative pain. Every 8 hours, the acute pain service recorded the analgesia regimen and occurrence of side effects. The initial infusion rate was tapered daily in response to improvement in pain symptoms or occurrence of side effects. Results A total of 3126 patients received TEA. The median age was 65 years (range, 18–94) and the duration of catheter placement was 3.5 days (range, 2–8). Three major complications were identified (1:1042): two subarachnoid blocks and one epidural abscess which led to permanent sequela (1:3126). Minor complications were hypotension (4.8%), pruritus (4.4%), accidental catheter removal (3.7%), insertion site inflammation (2.5%), motor weakness (2.0%), postoperative nausea and vomiting (1.8%), catheter disconnection (1.9%), catheter occlusion (0.3%), post-dural puncture headache (0.5%), and catheter fragment retention (0.06%), which were the reasons for a 7.4% rate of early discontinuation of epidural analgesia. No occurrence of epidural hematoma, local anesthetic systemic toxicity, and cardiovascular/respiratory depression was recorded. Conclusion Postoperative TEA is an advanced technique that poses certain difficulties that can subvert its great potential. While serious complications were rare, minor complications occurred more often and affected the postoperative course negatively. A risk/benefit evaluation of each patient should be done before employing the technique.

Accidental Epidural Catheter Removal Rates and Strength Required for Disconnection: a Retrospective Cohort and Experimental Study

“…Previous studies have reported disconnection rates in the range of 1.7-2.3% [4,19,20]; these rates were comparable with the rate in this study's old group, which was 1.9%. In the clinical study, there was a signi cant difference in disconnection rates among the groups; speci cally, these rates were highest in the new group and lowest in the taping group.…”

“…Previous studies have reported dislodgement rates in the range of 1.2-5.1% [4,19,20]. The present rates were comparable with or lower than those previously reported, suggesting that this approach may be bene cial.…”

“…To the best of our knowledge, this is the rst study examining accidental catheter removal rates and connection strength of epidural catheter connectors since the use of epidural connectors and lters has become the international standard. Several previous studies have investigated accidental removal rates of epidural catheters [4,19,20,23,24]; however, few clinical studies have directly compared epidural connector designs. Doyle et al [13] compared the connection strength of epidural catheter connectors using increment weight as a surrogate measure of linear force.…”

Case Report: Epidural Abscess Following Obstetric Epidural Anesthesia in Vietnam

“…S. aureus is one of the most frequent pathogens as its isolation was reported in more than half of epidural abscesses. 14 Gram-negative bacteria accounted for about 15–20%. 4 , 6 , 15 , 16 In our case, the organism isolated from both blood and purulent cultures was S. aureus .…”

Impact on Postoperative Pain and Recovery of a Regional Analgesia Strategy Based on the Surgical Approach for Lung Resection: A Prospective Observational Study

“…Thoracic epidural analgesia (TEA) has long been considered as the preferred technique of analgesia after thoracic surgery as it reduces postoperative pain after video-assisted thoracoscopic surgery (VATS) or thoracotomy, and reduces postoperative ileus [ 6 , 7 , 8 , 9 ]. However, epidural analgesia induces a sympathetic block that can cause intra- and postoperative hypotension and acute urinary retention, and catheter placement can lead to neurological damage in rare cases [ 10 , 11 ]. Thus, various other RA techniques have been developed and assessed in thoracic surgery, such as the paravertebral block, the erector spinae plane block (ESP), and intrathecal analgesia (IA) [ 12 ].…”