Major complications of epidural analgesia after surgery: results of a six‐year survey

Abstract

SummaryWe performed a retrospective case note review to identify the major complications of epidural analgesia occurring after surgery at our hospital. By cross-referencing the radiology, microbiology and patient information management system databases, we identified patients who had undergone either spinal magnetic resonance imaging or a lumbar puncture within 60 days of surgery in the period from January 2000 to December 2005. Review of these case notes identified six cases of epidural abscess, three of meningitis and three of epidural haematoma. Symptoms of epidural abscess or meningitis developed a median of 5 days after epidural catheter removal. Methicillinresistant Staphylococcus aureus was the predominant pathogen. Epidural haematoma symptoms developed while the epidural catheter was in place. These symptoms were initially attributed to the epidural infusion. Diagnostic delays contributed to adverse neurological outcome in three patients. This study suggests that leg weakness is a critical monitor of spinal cord health. A national database is needed to establish a more accurate estimate of the incidence of major complications and to identify relevant risk factors. Epidural analgesia can provide excellent pain relief and may decrease patient morbidity after major surgery [1][2][3]. However, this technique has significant risks including epidural abscess, meningitis and epidural haematoma. The reported incidence of these complications may be an underestimate, as it is based on case reports [4][5][6][7][8][9][10][11]. In January 2000, we started a survey to determine the incidence of these complications in patients receiving epidural analgesia after surgery in our hospital. MethodsThe survey took place from January 2000 to December 2005 and had Local Research Ethics Committee approval. At the end of each year we gathered data retrospectively from four sources: 1 The acute pain service: to identify all patients receiving epidural analgesia after surgery. 2 Microbiology department: to identify all cerebrospinal fluid (CSF) samples, epidural site swabs or epidural catheter tip specimens.3 Patient information management system (PiMS): to identify all patients undergoing surgery. 4 Radiology department: to identify all spinal magnetic resonance imaging (MRI) scans. Each source was asked to provide the patient's surname, forename, hospital number and date of birth, and where relevant the date of the procedure or specimen. The patient information management system also provided details of the operation performed and the surgical speciality.The data were imported into a database (ACCESS, Microsoft, Seattle, WA). As the acute pain service dataset did not include the hospital number or date of birth, we were unable to identify all patients undergoing investigation within 60 days of epidural analgesia. However, by cross-referencing the PiMS, microbiology and radiology data, we identified those patients who had undergone either a spinal MRI or relevant microbiological investigation within 60 days of surgery. The hospit...

Epidural analgesia: first do no harm

“…Multiple, non-randomised, small trials comparing epidural analgesia to 'older' opioid analgesia regimens have produced results that shaped modern practice but are rarely appropriate for modern anaesthesia [1]. Well-structured, randomised controlled trials are few and far between and those that have been performed must be used to guide modern practice [2]. Perceived best practice, influenced by how good the patients look in recovery, is not supported by the evidence to date.…”

Thromboseprophylaxe in der muskuloskelettalen Chirurgie

“…Unter Gerinnungshemmung wurden auch in anderen Publikationen wesentlich höhere Inzidenzen angegeben -bis zu 1:18.000 bei Epiduralanästhesie und 1:156.000 bei Spinalanästhesien [49]. Inzidenzzahlen aus aktuellen Registerdaten bestätigen die Größenordnung des Problems [48,[50][51][52][53][54][55].…”

Epidural haematomas

“…As a district general hospital anaesthetising morbidly obese patients with increasing frequency, we welcome the timely release of the Association of Anaesthetists' publication [1] offering guidance on the management of these patients. We would, however, like to add another important point that should be kept in mind when providing anaesthesia to this group of patients.…”

“…We would like to contribute to the points made by Christie and McCabe [1] with regard to the complications of epidural analgesia by reporting two cases of epidural haematoma following epidural insertion for postoperative analgesia occurring in our hospital.…”