Complications of Neuraxial Blocks

Complications of Neuraxial Blocks

The complications of epidural, spinal, or caudal anesthetics range from the bothersome to the crip-pling and life-threatening (Table 45–6). Broadly, the complications can be thought of as those resulting

from excessive effects of an appropriately injected drug, placement of the needle (or catheter), and sys-temic drug toxicity.

A very large survey of regional anesthesia from France provides an indication of the relatively low incidence of serious complications from spinal and epidural anesthesia (Table 45–7). The American Society of Anesthesiologists (ASA) Closed Claims Project helps to identify the most common causes of liability claims involving regional anesthesia in the operating room setting. In a 20-year period (1980– 1999), regional anesthesia accounted for 18% of all liability claims. In the majority of these claims, the injuries were judged as temporary or nondisabling (64%). Serious injuries in the remaining claims included death (13%), permanent nerve injury (10%), permanent brain damage (8%), and other permanent injuries (4%). The majority of regional anesthesia claims involved either lumbar epidural anesthesia (42%) or spinal anesthesia (34%) and tended to occur mostly in obstetric patients. The latter may at least partly reflect the relatively higher use of neuraxial anesthesia compared with other regional techniques and its relatively very high uti-lization in obstetric patients. Of note is that caudal anesthesia was utilized in only 2% of claims.