Skip to main content Accessibility help

We use cookies to distinguish you from other users and to provide you with a better experience on our websites. Close this message to accept cookies or find out how to manage your cookie settings.

Close cookie message
×
Hostname: page-component-78c5997874-t5tsf Total loading time: 0 Render date: 2024-11-02T19:02:34.760Z Has data issue: false hasContentIssue false

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
Get access

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

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Abrahams, MS, Aziz, MF, Fu, RF, Horn, JL. (2009) Ultrasound guidance compared with electrical neurostimulation for peripheral nerve block: a systematic review and meta-analysis of randomized controlled trials. Br J Anaesth. 102,408–17.Google Scholar
Barson, AJ, Chistwick, ML, Doig, CM. (1978) Fat embolism in infancy after intravenous fat infusions. Arch Dis Child. 53,218–23.CrossRefGoogle Scholar
Berde, CB. (1993) Toxicity of local anesthetics in infants and children.J Pediatr. 122,S14–20.Google Scholar
Bernards, CM, Hadzic, A, Suresh, S, Neal, JM. (2008) Regional anesthesia in anesthetized or heavily sedated patients. Reg Anesth Pain Med. 33,449–60.CrossRefGoogle Scholar
Boretsky, KR. (2014) Regional anesthesia in pediatrics: marching forward. Curr Opin Anaesthesiol. 27,556–60.Google Scholar
Borgeat, A, Blumenthal, S. (2004) Nerve injury and regional anaesthesia. Curr Opin Anaesthesiol 17,417–21.CrossRefGoogle Scholar
Chalkiadis, GA, Abdullah, F, Bjorksten, AR, et al. (2013) Absorption characteristics of epidural levobupivacaine with adrenaline and clonidine in children. Paediatr Anaesth. 23,58–67.Google Scholar
Dadure, C, Capdevila, X. (2012) Peripheral catheter techniques. Paediatr Anaesth. 22, 93–101.Google Scholar
Dahlgren, N, Torenbrandt, K. Neurological complications after anesthesia. A follow-up of 18 000 spinal and epidural anesthetics performed over 3 years. (1995) Acta Anaesthiol Scand. 39,872–88.Google Scholar
Dalens, B. (2006) Some current controversies in paediatric regional anaesthesia. Curr Opin Anaesthesiol. 19, 301–8.CrossRefGoogle Scholar
De José María, B, Banús, E, Navarro Egea, M, et al. (2008) Ultrasound-guided supraclavicular vs. infraclavicular brachial plexus blocks in children. Paediatr Anaesth. 18, 838–44.Google Scholar
de Queiroz Siqueira, M, Chassard, D, Musard, H, et al. (2014) Resuscitation with lipid, epinephrine, or both in levobupivacaine-induced cardiac toxicity in newborn piglets. Br J Anaesth. 112, 729–34.CrossRefGoogle Scholar
Dippenaar, JM. (2007) Local anaesthetic toxicity. SAJAA.13, 23–28.Google Scholar
Ecoffey, C. (2012) Safety in pediatric regional anaesthesia. Pediatr Anaesth. 22,25–30.Google Scholar
Ecoffey, C, Lacroix, F, Giaufré, E, Orliaguet, G, Courrèges, P; Association des Anesthésistes Réanimateurs Pédiatriques d'Expression Française (ADARPEF). (2010) Epidemiology and morbidity of regional anesthesia in children: a follow-up one-year prospective survey of the French-Language Society of Paediatric Anaesthesiologists (ADARPEF). Paediatr Anaesth. 20,1061–9.CrossRefGoogle Scholar
Ecoffey, C, Oger, E, Marchand-Maillet, F, et al. (2014) Complications associated with 27 031 ultrasound-guided axillary brachial plexus blocks: a web-based survey of 36 French centres. Eur J Anaesthesiol. 31,606–10.Google Scholar
Fisher, QA, Shaffner, DH, Yaster, M. (1997) Detection of intravascular injection of regional anaesthetics in children. Can J Anaesth. 44,592–8.CrossRefGoogle Scholar
Flandin-Blety, C, Barrier, G. (1995) Accidents following epidural anesthesia in children. The results of a retrospective study. Paediatr Anaesth. 5:41–6.CrossRefGoogle Scholar
Ganesh, A, Rose, JB, Wells, L, et al. (2007) Continuous peripheral nerve blockade for inpatient and outpatient postoperative analgesia in children. Anesth Analg. 105,1234–42.Google Scholar
Gregory, GA, Andropoulos, DB. (2012) Pediatric Anesthesia., Hoboken, NJ: Wiley Blackwell.
Griffin, J, Nicholls, B. (2010) Ultrasound in regional anaesthesia. Anaesthesia. 65(S1),1–12.Google Scholar
Krane, EJ, Dalens, BJ, Murat, I, Murrell, D. (1998) The safety of epidurals placed during general anesthesia. Reg Anesth Pain Med. 23,433–8.Google Scholar
Kuo, I, Akpa, BS. (2013) Validity of the lipid sink as a mechanism for the reversal of local anesthetic systemic toxicity: a physiologically based pharmacokinetic model study. Anesthesiology. 118,1350–61CrossRefGoogle Scholar
Lei, SY, Hache, M, Loepke, AW. (2014) Clinical research into anesthetic neurotoxicity: does anesthesia cause neurological abnormalities in humans? J Neurosurg Anesthesiol. 26,349–57.Google Scholar
Llewellyn, N, Moriarty, A. (2007) The national pediatric epidural audit. Paediatr Anaesth. 17,520–33.CrossRefGoogle Scholar
Lönnqvist, PA. (2012) Toxicity of local anesthetic drugs: a pediatric perspective. Paediatr Anaesth. 22,39–43.Google Scholar
Ludot, H, Tharin, JY, Belouadah, M, Mazoit, JX, Malinovsky, JM. (2008) Successful resuscitation after ropivacaine and lidocaine-induced ventricular arrhythmia following posterior lumbar plexus block in a child. Anesth Analg. 106,1572–4.CrossRefGoogle Scholar
Luz, G, Wieser, C, Innerhofer, P, et al.(1998) Free and total bupivacaine plasma concentrations after continuous epidural anaesthesia in infants and children. Paediatr Anaesth. 8,473–8.Google Scholar
Marhofer, P, Sitzwohl, C, Greher, M, Kapral, S. (2004)Ultrasound guidance for infraclavicular brachial plexus anaesthesia in children. Anaesthesia. 59,642–6.Google Scholar
Neal, JM, Bernards, CM, Hadzic, A, et al. (2008) ASRA practice advisory on neurologic complications in regional anesthesia and pain medicine. Reg Anesth Pain Med. 33,404–15.CrossRefGoogle Scholar
Oberndorfer, U, Marhofer, P, Bösenberg, A, et al. (2007)Ultrasonographic guidance for sciatic and femoral nerve blocks in children. Br J Anaesth. 98,797–801.Google Scholar
Peters, AM, Snelling, HL, Glass, DM, Bird, NJ. (2011) Estimation of lean body mass in children. Br J Anaesth. 106,719–23.CrossRefGoogle Scholar
Polaner, DM, Zuk, J, Luong, K, Pan, Z. (2010) Positive intravascular test dose criteria in children during total intravenous anesthesia with propofol and remifentanil are different than during inhaled anesthesia. Anesth Analg. 110,41–5.CrossRefGoogle Scholar
Polaner, DM, Taenzer, AH, Walker, BJ, et al. (2012) Pediatric Regional Anesthesia Network (PRAN): a multi-institutional study of the use and incidence of complications of pediatric regional anesthesia. Anesth Analg. 115,1353–64.CrossRefGoogle Scholar
Ponde, VC, Diwan, S. (2009) Does ultrasound guidance improve the success rate of infraclavicular brachial plexus block when compared with nerve stimulation in children with radial club hands? Anesth Analg. 108,1967–70.Google Scholar
Ponde, VC, Desai, AP, Shah, D. (2013) Comparison of success rate of ultrasound-guided sciatic and femoral nerve block and neurostimulation in children with arthrogryposis multiplex congenita: a randomized clinical trial. Paediatr Anaesth. 23,74–8.Google Scholar
Presley, JD, Chyka, PA. (2013) Intravenous lipid emulsion to reverse acute drug toxicity in pediatric patients. Ann Pharmacother. 47,735–43.Google Scholar
Puncuh, F, Lampugnani, E, Kokki, H. (2004) Use of spinal anaesthesia in paediatric patients: a single centre experience with 1132 cases. Paediatr Anaesth. 14,564–7.Google Scholar
Rubin, K, Sullivan, D, Sadhasivam, S. (2009) Are peripheral and neuraxial blocks with ultrasound guidance more effective and safe in children? Paediatr Anaesth. 19,92–6.Google Scholar
Sethna, N, Clendenin, D, Athiraaman, U, et al. (2010) Incidence of epidural catheter-associated infections and continuous epidural analgesia in children. Anesthesiology. 113,224–32CrossRefGoogle Scholar
Shah, RD, Suresh, S. (2013) Applications of regional anaesthesia in paediatrics. Br J Anaesth.111(Suppl. 1),114–24.Google Scholar
Shah, S, Gopalakrishnan, S, Apuya, J, Shah, S, Martin, T. (2009) Use of Intralipid in an infant with impending cardiovascular collapse due to local anesthetic toxicity. J Anesth. 23,439–41.CrossRefGoogle Scholar
Shenoy, U, Paul, J, Antony, D. (2014) Lipid resuscitation in pediatric patients – need for caution? Paediatr Anaesth. 24,332–4.Google Scholar
Strafford, MA, Wilder, RT, Berde, CB. (1995) The risk of infection from epidural analgesia in children: a review of 1620 cases. Anesth Analg. 80,234–8.Google Scholar
Taenzer, AH, Walker, BJ, Bosenberg, AT, et al. (2014a) Asleep versus awake: does it matter? Pediatric regional block complications by patient state: a report from the Pediatric Regional Anesthesia Network. Reg Anesth Pain Med. 39,279–83.Google Scholar
Taenzer, AH, Walker, BJ, Bosenberg, AT, et al. (2014b) Interscalene brachial plexus blocks under general anesthesia in children: is this safe practice? A report from the Pediatric Regional Anesthesia Network (PRAN). Reg Anesth Pain Med. 39,502–5.Google Scholar
Varghese, E, Deepak, KM, Chowdary, KV. (2009). Epinephrine test dose in children: is it interpretable on ECG monitor? Paediatr Anaesth. 19,1090–5.Google Scholar
Weinberg, GL. (2012) Lipid emulsion infusion: resuscitation for local anesthetic and other drug overdose. Anesthesiology. 1,180–7.Google Scholar
Weinberg, GL, VadeBoncouer, T, Ramaraju, GA, Garcia-Amaro, MF, Cwik, MJ. (1998) Pretreatment or resuscitation with a lipid infusion shifts the dose-response to bupivacaine-induced asystole in rats. Anesthesiology. 88,1071–5.Google Scholar

Save book to Kindle

To save this book to your Kindle, first ensure [email protected] is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Available formats
×

Save book to Dropbox

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.

Available formats
×

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

Available formats
×