Serious complications associated with spinal and epidural anaesthesia in <scp>F</scp>inland from 2000 to 2009

Pitkänen, M.; Aromaa, U.; Cozanitis, D. A.; Förster, J. G.

doi:10.1111/aas.12064

Cited by 96 publications

(74 citation statements)

References 50 publications

(68 reference statements)

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“…The risk of neuraxial haematoma was far greater with epidural analgesia (1 : 26 400) than spinal anaesthesia (1 : 775 000). 56 A much higher risk was noted in a recent audit report of over 35 000 patients from the USA: cardiac arrest 1 : 5000, epidural abscess 1:27 000 and epidural haematoma 1 : 5400. 57 In making the decision to use epidural analgesia, the failure rate has to be taken into consideration.…”

Section: Regional Anaesthesia Techniquesmentioning

confidence: 92%

Current issues in postoperative pain management

Rawal

2016

European Journal of Anaesthesiology

361

233

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Postoperative pain has been poorly managed for decades. Recent surveys from USA and Europe do not show any major improvement. Persistent postoperative pain is common after most surgical procedures, and after thoracotomy and mastectomy, about 50% of patients may experience it. Opioids remain the mainstay of postoperative pain treatment in spite of strong evidence of their drawbacks. Multimodal analgesic techniques are widely used but new evidence is disappointing. Regional anaesthetic techniques are the most effective methods to treat postoperative pain. Current evidence suggests that epidural analgesia can no longer be considered the 'gold standard'. Perineural techniques are good alternatives for major orthopaedic surgery but remain underused. Infiltrative techniques with or without catheters are useful for almost all types of surgery. Simple surgeon-delivered local anaesthetic techniques such as wound infiltration, preperitoneal/intraperitoneal administration, transversus abdominis plane block and local infiltration analgesia can play a significant role in improvement of postoperative care, and the last of these has changed orthopaedic practice in many institutions. Current postoperative pain management guidelines are generally 'one size fits all'. It is well known that pain characteristics such as type, location, intensity and duration vary considerably after different surgical procedures. Procedure-specific postoperative pain management recommendations are evidence based, and also take into consideration the role of anaesthetic and surgical techniques, clinical routines and risk-benefit aspects. The role of acute pain services to improve pain management and outcome is well accepted but implementation seems challenging. The need for upgrading the role of surgical ward nurses and collaboration with surgeons to implement enhanced recovery after surgery protocols with regular audits to improve postoperative outcome cannot be overstated.

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Section: Regional Anaesthesia Techniquesmentioning

confidence: 92%

Current issues in postoperative pain management

Rawal

2016

European Journal of Anaesthesiology

361

233

View full text Add to dashboard Cite

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“…21 There were 28% to 45% of patients in different groups needed a rescue antipruritic agent such as naloxane. Recently, Pitkanen and coworkers 22 revealed that the rate of fatality and neuraxial hematoma are significantly higher in epidural and CSEA than spinal anesthesia. The lateral holes of the epidural catheter may lie near to the dural puncture site; thus, injection of a bolus solution of drug through the epidural catheter has the potential risk of leakage from the dural puncture into the subarachnoid space.…”

mentioning

confidence: 99%