Book Text

COMPLICATIONS

Epidemiology

Regional anesthetic technique can infrequently cause local, regional, or general complications. Few data are available. The first study based on the American Society of Anesthesiologists (ASA) closed malpractice claim involved 238 pediatric cases, including only 7 children who had received a regional anesthesia ^[138] ; however, this low rate is not significant because the overall number of children given a conduction block was low during the evaluation period. The Australian Incident Monitoring Study^[139] reported 2000 claims, including 160 pediatric cases involving regional anesthesia techniques (i.e., 83 epidurals, 42 spinals, 14 brachial plexus, 4 intravenous regional anesthetics, 3 ophthalmic blocks, and 14 local infiltrations); the largest single cause was circulatory problems, and there

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**TABLE 45-7** -- Basic safety rules for regional or local anesthesia
1. Select the least hazardous technique for a given block.
2. Even in emergency situations, provide full details concerning the scheduled anesthetic management, including beneficial and potentially detrimental effects.
3. Envisage the possibility of a block failure, and explain what replacement procedures will be used.
4. Obtain written consent for anesthesia care.
5. Evaluate carefully the physical status of the patient, and ask for complementary laboratory, radiographic, or other examinations when useful.
6. Manage the patient in the same way and with the same monitoring procedures as for general anesthesia, and complete a detailed anesthesia chart.
7. Treat all complications.
8. Complete a postanesthesia chart to evaluate precise recovery of the block and to avoid irrelevant claims.
9. Hospitalize all patients given epidural or intrathecal morphine in postanesthesia care units, where respiratory parameters are first recorded hourly for the first 12 hours, and then every 2 hours for the first 24 hours postoperatively.

were 24 drug errors (including 10 "wrong drugs" and 14 cases of "inappropriate use"). The 1-year prospective study of the French-Language Society of Pediatric Anesthesiologists (Association des Anesthésistes Réanimateurs Pédiatríques d'Expression Française [ADARPEF]) evaluated 85,412 pediatric anesthetics, including 24,409 regional anesthesias. There were 23 complications (no sequelae, no deaths, and no legal consequences), all occurring after neuraxial blocks. These studies show that complications of regional anesthesia are rare. They are mainly reported after neuraxial blocks and often follow the use of wrong equipment and drug errors. These complications can be related to the block procedure itself (e.g., needle and catheter trauma, adverse effects of local anesthetics), the physical status of the patient, or the insufficient quality of anesthesia care.^[119] ^[120] ^[140]