SERIOUS COMPLICATIONS RELATED TO REGIONAL ANESTHESIA - RESULTS OF A PROSPECTIVE SURVEY IN FRANCE

Background: Serious complications related to regional anesthesia have previously been described primarily in case reports and retrospective surveys. The authors prospectively evaluated a multicenter series of r egional anesthetics, using preplanned criteria to measure the incidenc e and characteristics of associated serious complications. Methods: Re quests were sent to 4,927 French anesthesiologists in advance of a sub sequent 5-month study period. Participating anesthesiologists were ask ed for detailed reports of serious complications occurring during or a fter regional anesthetics performed by them during the study interval. Details regarding each complication then were obtained via a second q uestionnaire. Results: The number of responding anesthesiologists was 736. The number of regional anesthetics performed was 103,730, corresp onding to 40,640 spinal anesthetics, 30,413 epidural anesthetics, 21,2 78 peripheral nerve blocks, and 11,229 intravenous regional anesthetic s. Reports of 98 severe complications were received, with follow-up in formation being obtained for 97. In 89 cases, complications were attri buted fully or partially to regional anesthesia. Thirty-two cardiac ar rests, seven of which were fatal, occurred during the study. Of these, 26 occurred during spinal anesthesia, with 6 being fatal, 3 occurred during epidural anesthesia, and 3 more occurred during peripheral bloc ks. The higher incidence of cardiac arrest during spinal anesthesia (6 .4 +/- 1.2 per 10,000 patients) compared with all other regional anest hesia (1.0 +/- 0.4 per 10,000 patients) was statistically significant (P < 0.05). Of 34 neurologic complications (radiculopathy, cauda equin a syndrome, paraplegia), 21 were associated either with paresthesia du ring puncture (n = 19) or with pain during injection (n = 2), suggesti ng nerve trauma or intraneural injection. Twelve patients who had neur ologic complications after spinal anesthetics had no paresthesia durin g needle placement and no pain on injection. Of these 12 patients (7 w ith radiculopathy and 5 with cauda equina syndrome), 9 received intrat hecal hyperbaric lidocaine, 5%. The incidence of neurologic injury was significantly greater after spinal anesthesia (6 +/- 1 per 10,000 cas es; P < 0.05) than after each of the other types of regional procedure s (1.6 +/- 0.5 per 10,000 cases for the weighted average). Seizures at tributed to elevated serum levels of local anesthetics occurred in 23 patients, but none suffered a cardiac arrest. Conclusions: (1) The inc idence of cardiac arrest and neurologic injury related to regional ane sthesia were very low, but both were more than three SDs greater after spinal anesthesia than after other regional procedures. (2) Two third s of the patients with neurologic deficits had either-a paresthesia du ring needle placement or pain on injection. (3) Seventy-five percent o f the neurologic deficits after nontraumatic spinal anesthesia occurre d in patients who had received hyperbaric lidocaine, 5%.