Major complications related to epidural analgesia in children: a 15-year audit of 3,152 epidurals

Wong, Gail; Arab, Abeer A.; Chew, Sue C.; Naser, Basem; Crawford, Mark W.

doi:10.1007/s12630-012-9877-3

Cited by 45 publications

(42 citation statements)

References 37 publications

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“…It is noteworthy that there is considerable heterogeneity with regard to the country in which the study took place, including European, North American, African, and Asian nations. Time period of patient observation is also an important source of heterogeneity among included studies.…”

Section: Discussionmentioning

confidence: 99%

Frequency of medication error in pediatric anesthesia: A systematic review and meta‐analytic estimate

Feinstein

Pannunzio

Castro

2018

Pediatric Anesthesia

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Summary Background Clinical evidence shows that pediatric anesthesia patients are subject to a higher rate of life‐threatening medical errors than their adult counterparts. Medication error in adult anesthesia is estimated to occur to 1 in 133 anesthetic administrations, but such a figure has not been determined for pediatric anesthesia patients. Individual studies of medication error in pediatric anesthesia have ranged from rates of 0.01% to 1.92% of anesthetic uses. The present study is a systematic review that employs a meta‐analytic estimate to determine the rate of medication error in pediatric anesthesia. Methods A systematic review of the literature on pediatric anesthesia medication error was conducted using Medline, Cochrane Database, PROSPERO, and Clinicaltrials.gov. A meta‐analytic estimate was used to determine the medication error rate for all of the included studies. Subgroup sensitivity analysis was used to evaluate possible sources of heterogeneity in included studies. Results Of the 433 initially screened records, 13 studies met inclusion criteria. Meta‐analytic estimate of medication error rate across all studies was 0.08% (95% CI 0.05%‐0.10%), or 1 out of 1250 anesthetics. Ten different countries were represented in the studies. Sample size of anesthetics reported on ranged from 296 to 2 316 635. Data collecting periods ranged from 3 months to 15 years. Six included studies individually reported higher rates of medication error in patients under 1 year of age. Conclusion The present systematic review revealed a medication error rate of 1 per 1250 anesthetic administrations in pediatric anesthesia. This result is significantly lower than would be expected given reported rates of medication error in adult anesthesia, which raises questions regarding the validity of research methods and reporting of medication error in pediatric anesthesia. Future investigations of medication error should employ methodologies other than self‐reporting of error, such as retrospective chart review.

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Section: Discussionmentioning

confidence: 99%

Frequency of medication error in pediatric anesthesia: A systematic review and meta‐analytic estimate

Feinstein

Pannunzio

Castro

2018

Pediatric Anesthesia

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“…Entering the epidural space at the sacrococcygeal ligament and advancing a catheter up towards the area of pathology should theoretically reduce the incidence of inadvertent dural puncture. Although this has yet to be formally examined, it is likely that the development and risk of serious neurological complications resulting from hematoma formation may be less with a fluoroscopically-guided caudal approach, as the entry point into the epidural space is more superficial; the area is more compressible than in the lumbar and cervical spinal regions; and the nerve roots that innervate the lower extremities and most of the bowel and bladder are located more cephalad [69,70]. …”

Section: Complicationsmentioning

confidence: 99%

Epidural Lysis of Adhesions

et al. 2014

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As our population ages and the rate of spine surgery continues to rise, the use epidural lysis of adhesions (LOA) has emerged as a popular treatment to treat spinal stenosis and failed back surgery syndrome. There is moderate evidence that percutaneous LOA is more effective than conventional ESI for both failed back surgery syndrome, spinal stenosis, and lumbar radiculopathy. For cervical HNP, cervical stenosis and mechanical pain not associated with nerve root involvement, the evidence is anecdotal. The benefits of LOA stem from a combination of factors to include the high volumes administered and the use of hypertonic saline. Hyaluronidase has been shown in most, but not all studies to improve treatment outcomes. Although infrequent, complications are more likely to occur after epidural LOA than after conventional epidural steroid injections.

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“…Large series from the United Kingdom , Europe , United States , and Canada demonstrate low complication rates following neuraxial analgesia in children, but rates are higher for central vs peripheral blocks . In early series, neonates were at greater risk and also had worse outcomes .…”

Section: Regional Analgesiamentioning

confidence: 99%

Neonatal pain

Walker

2013

Pediatric Anesthesia

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Effective management of procedural and postoperative pain in neonates is required to minimize acute physiological and behavioral distress and may also improve acute and long-term outcomes. Painful stimuli activate nociceptive pathways, from the periphery to the cortex, in neonates and behavioral responses form the basis for validated pain assessment tools. However, there is an increasing awareness of the need to not only reduce acute behavioral responses to pain in neonates, but also to protect the developing nervous system from persistent sensitization of pain pathways and potential damaging effects of altered neural activity on central nervous system development. Analgesic requirements are influenced by age-related changes in both pharmacokinetic and pharmacodynamic response, and increasing data are available to guide safe and effective dosing with opioids and paracetamol. Regional analgesic techniques provide effective perioperative analgesia, but higher complication rates in neonates emphasize the importance of monitoring and choice of the most appropriate drug and dose. There have been significant improvements in the understanding and management of neonatal pain, but additional research evidence will further reduce the need to extrapolate data from older age groups. Translation into improved clinical care will continue to depend on an integrated approach to implementation that encompasses assessment and titration against individual response, education and training, and audit and feedback.

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Major complications related to epidural analgesia in children: a 15-year audit of 3,152 epidurals

Cited by 45 publications

References 37 publications

Frequency of medication error in pediatric anesthesia: A systematic review and meta‐analytic estimate

Frequency of medication error in pediatric anesthesia: A systematic review and meta‐analytic estimate

Epidural Lysis of Adhesions

Neonatal pain

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