TY - JOUR
T1 - Complications in Pediatric Regional Anesthesia
T2 - An Analysis of More than 100,000 Blocks from the Pediatric Regional Anesthesia Network
AU - Pediatric Regional Anesthesia Network Investigators
AU - Walker, Benjamin J
AU - Long, Justin B
AU - Sathyamoorthy, Madhankumar
AU - Birstler, Jennifer
AU - Wolf, Christine
AU - Bosenberg, Adrian T
AU - Flack, Sean H
AU - Krane, Elliot J
AU - Sethna, Navil F
AU - Suresh, Santhanam
AU - Taenzer, Andreas H
AU - Polaner, David M
AU - Martin, Lynn
AU - Anderson, Corrie
AU - Sunder, Rani
AU - Adams, Trevor
AU - Martin, Lizabeth
AU - Pankovich, Martha
AU - Sawardekar, Amod
AU - Birmingham, Patrick
AU - Marcelino, Ryan
AU - Ramarmurthi, R J
AU - Szmuk, Peter
AU - Ungar, Galit Kastner
AU - Lozano, Sara
AU - Boretsky, Karen
AU - Jain, Ranu
AU - Matuszczak, Maria
AU - Petersen, Timothy R
AU - Dillow, Jennifer
AU - Power, Robert
AU - Nguyen, Kim
AU - Lee, Benjamin H
AU - Chan, Lisa
AU - Pineda, Jorge
AU - Hutchins, Jacob
AU - Mendoza, Kimberly
AU - Spisak, Kristen
AU - Shah, Aali
AU - DelPizzo, Kathryn
AU - Dong, Naomi
AU - Yalamanchili, Vidya
AU - Venable, Claudia
AU - Williams, Cassandra Armstead
AU - Chaudahari, Reena
AU - Ohkawa, Susumu
AU - Usljebrka, Helga
AU - Bhalla, Tarun
AU - Vanzillotta, Pedro Paulo
AU - Apiliogullari, Seza
PY - 2018/10
Y1 - 2018/10
N2 - WHAT WE ALREADY KNOW ABOUT THIS TOPIC: WHAT THIS ARTICLE TELLS US THAT IS NEW: BACKGROUND:: Complications in pediatric regional anesthesia are rare, so a large sample size is necessary to quantify risk. The Pediatric Regional Anesthesia Network contains data on more than 100,000 blocks administered at more than 20 children's hospitals. This study analyzed the risk of major complications associated with regional anesthesia in children.METHODS: This is a prospective, observational study of routine clinical practice. Data were collected on every regional block placed by an anesthesiologist at participating institutions and were uploaded to a secure database. The data were audited at multiple points for accuracy.RESULTS: There were no permanent neurologic deficits reported (95% CI, 0 to 0.4:10,000). The risk of transient neurologic deficit was 2.4:10,000 (95% CI, 1.6 to 3.6:10,000) and was not different between peripheral and neuraxial blocks. The risk of severe local anesthetic systemic toxicity was 0.76:10,000 (95% CI, 0.3 to 1.6:10,000); the majority of cases occurred in infants. There was one epidural abscess reported (0.76:10,000, 95% CI, 0 to 4.8:10,000). The incidence of cutaneous infections was 0.5% (53:10,000, 95% CI, 43 to 64:10,000). There were no hematomas associated with neuraxial catheters (95% CI, 0 to 3.5:10,000), but one epidural hematoma occurred with a paravertebral catheter. No additional risk was observed with placing blocks under general anesthesia. The most common adverse events were benign catheter-related failures (4%).CONCLUSIONS: The data from this study demonstrate a level of safety in pediatric regional anesthesia that is comparable to adult practice and confirms the safety of placing blocks under general anesthesia in children.
AB - WHAT WE ALREADY KNOW ABOUT THIS TOPIC: WHAT THIS ARTICLE TELLS US THAT IS NEW: BACKGROUND:: Complications in pediatric regional anesthesia are rare, so a large sample size is necessary to quantify risk. The Pediatric Regional Anesthesia Network contains data on more than 100,000 blocks administered at more than 20 children's hospitals. This study analyzed the risk of major complications associated with regional anesthesia in children.METHODS: This is a prospective, observational study of routine clinical practice. Data were collected on every regional block placed by an anesthesiologist at participating institutions and were uploaded to a secure database. The data were audited at multiple points for accuracy.RESULTS: There were no permanent neurologic deficits reported (95% CI, 0 to 0.4:10,000). The risk of transient neurologic deficit was 2.4:10,000 (95% CI, 1.6 to 3.6:10,000) and was not different between peripheral and neuraxial blocks. The risk of severe local anesthetic systemic toxicity was 0.76:10,000 (95% CI, 0.3 to 1.6:10,000); the majority of cases occurred in infants. There was one epidural abscess reported (0.76:10,000, 95% CI, 0 to 4.8:10,000). The incidence of cutaneous infections was 0.5% (53:10,000, 95% CI, 43 to 64:10,000). There were no hematomas associated with neuraxial catheters (95% CI, 0 to 3.5:10,000), but one epidural hematoma occurred with a paravertebral catheter. No additional risk was observed with placing blocks under general anesthesia. The most common adverse events were benign catheter-related failures (4%).CONCLUSIONS: The data from this study demonstrate a level of safety in pediatric regional anesthesia that is comparable to adult practice and confirms the safety of placing blocks under general anesthesia in children.
KW - Anesthesia, Conduction/adverse effects
KW - Anesthetics, Local/administration & dosage
KW - Child
KW - Child, Preschool
KW - Cohort Studies
KW - Female
KW - Humans
KW - Infant
KW - Infant, Newborn
KW - Male
KW - Nerve Block/adverse effects
KW - Postoperative Complications/chemically induced
KW - Prospective Studies
U2 - 10.1097/ALN.0000000000002372
DO - 10.1097/ALN.0000000000002372
M3 - Article
C2 - 30074928
SN - 0003-3022
VL - 129
SP - 721
EP - 732
JO - Anesthesiology
JF - Anesthesiology
IS - 4
ER -