The National Pediatric Epidural Audit

Abstract

SummaryBackground: This paper describes a prospective audit of children receiving epidural infusion analgesia (EIA) in Great Britain and Ireland. The aim was to quantify the risks associated with this technique. Methods: In order to obtain sufficient data on the number of pediatric epidurals performed and the incidence of unwanted events, a decision was taken, at an Annual Meeting of Great Britain and Ireland Paediatric Pain Services, to establish a national audit of EIA practice in these centers. Each site sent a monthly return of the numbers of EIA performed to the coordinating center. If an incident occurred then the referring site completed a more detailed form and the child was followed up for 1 year if possible. Incidents were graded by severity 1-3, serious to minor. These data were collected over the 5-year period (2001)(2002)(2003)(2004)(2005). (v) Only one child has residual effects from a grade 1 incident 12 months after surgery (approximately 1 : 10 000). (vi) Forty incidents were also reported that were felt to be associated with the use of EIA; 33 of these incidents were the development of pressures sores. Four incidents of compartment syndrome were reported, in each of these cases the presence of EIA did not mask the condition. Conclusions: Epidural infusion analgesia in children does have risks associated with the technique. The occurrence of compartment syndrome does not appear to be masked by the presence of working EIA. As a result of this audit we can now provide parents with better information, thereby improving the process of informed consent.

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

“…19 We did not include common transient complications, such as pruritus, nausea, vomiting, excessive motor block (with the exception of total spinal anesthesia), or inadequate sensory block.…”

“…19 Grade 3 complications were defined as those that were immediately life-threatening or that resulted in permanent deficit; grade 2 complications were those that resolved with intervention, and grade 1 complications were those that resolved without intervention.…”

“…[14][15][16] In the larger pediatric studies that do exist, the reported incidence of complications in children is almost ten-fold greater than in adults, ranging from 40-90 in 10,000 epidurals. [17][18][19][20] Two prospective studies 18,19 that report the incidence of complications with epidural analgesia in children were reliant on self-reported or questionnaire-based data. While the accuracy of data in these studies may be limited by underreporting of complications and selection or recall bias, both studies were multicentre studies with patient numbers in excess of 10,000 and provide the best quality of evidence thus far.…”

National Audit Project (NAP) summaries

“…The census phase of the project produced estimates of 3,125 epidurals, 325 spinals and 18,050 caudals performed in a year in the UK. This is the smallest sub group in the census being half the number of chronic pain CNBs and Table 1 Serious complications following 10,000 continuous epidurals in children Llewellyn et al, 2007. 14 Clinical reviews by indication…”

From the Journal archives: Epidural anesthesia in young children: What have we learned in the past 60 years?

“…15 Only one case of persistent neurological damage was recorded, which occurred in a 3.2-kg fourmonth-old who developed cauda equina syndrome due to an infusion pump malfunction. As reported in 2012, important work on the topic of complications of pediatric regional anesthesia is being conducted in the USA by the Pediatric Regional Anesthesia Network (PRAN).…”