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4 - Management of complications of regional anesthesia

from Section 1 - Principles and practice

Published online by Cambridge University Press:  05 September 2015

By
Immanuel Hennessy  and
Stephen Mannion
Edited by
Stephen Mannion ,
Gabrielle Iohom ,
Christophe Dadure ,
Mark D. Reisbig  and
Arjunan Ganesh
Immanuel Hennessy
Affiliation:
Victoria University Hospital, Cork, Ireland
Stephen Mannion
Affiliation:
University College Cork, Ireland
Stephen Mannion
Affiliation:
University College Cork
Gabrielle Iohom
Affiliation:
University College Cork
Christophe Dadure
Affiliation:
Hôpital Lapeyronie, Montpellier
Mark D. Reisbig
Affiliation:
Creighton University Medical Center, Omaha, Nebraska
Arjunan Ganesh
Affiliation:
Children’s Hospital of Philadelphia
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Summary

Introduction

Regional anesthesia in children is safe. Serious complications such as nerve injury, systemic toxicity, serious infections, and visceral or dural punctures are very rare.

Complications following regional anesthesia can be minimized through good clinical practice, and there is increasing evidence that ultrasonography may play an increasing role in further enhancing safety (Griffin and Nicholls, 2010).

Recently three large databases have provided prospective data on the complications of regional anesthesia in children. The Pediatric Regional Anesthesia Network (PRAN) study (Polaner et al., 2012), the French-Language Society of Pediatric Anesthesiologists (ADARPEF) survey (Ecoffey et al., 2010), and the National Paediatric Epidural Audit (NPEA) from the UK and Ireland (Llewellyn and Moriarty, 2007), together have reported on the complication rates relating to 56 682 regional anesthetic procedures in children.

Overall the reported risk of serious complications in these studies has been shown to be very low. Notably there were no deaths from regional anesthesia reported in any of these studies. There was only 1 case of morbidity with effects lasting greater than 1 year. This case was reported in the NPEA and involved a 4-month-old child, who had a partial neurologic deficit still present 1 year after an epidural drug error. The incidence of serious complications in the French and American databases ranged from 0.12 to 0.15%. In all these cases, resolution of the complication occurred by the studies' follow-up times of 3 months (PRAN) or 1 year (ADARPEF).

These data are reassuring as regards the safety profile of regional anesthesia in children; however, they should not lead to complacency as the risk is never zero (Boretsky, 2014).

This chapter will discuss the types of major complications after regional anesthesia in children and describe the management of each of these.

Local anesthetic systemic toxicity

In children, local anesthetic systemic toxicity (LAST) following regional anesthesia is an extremely rare but potentially life-threatening condition. The risk of developing LAST is estimated to be 0 to 2:10 000 from prospective databases (PRAN/ADARPEF/NPEA). This is similar to the risk of LAST in adults, which was recently estimated to be 0.37:10 000 (Ecoffey et al., 2014).

Type
Chapter
Information
Ultrasound-Guided Regional Anesthesia in Children
A Practical Guide
 , pp. 20 - 29
Publisher: Cambridge University Press
Print publication year: 2015

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