SEVERE COMPLICATIONS ASSOCIATED WITH EPIDURAL AND SPINAL ANAESTHESIASIN FINLAND 1987-1993 - A STUDY BASED ON PATIENT INSURANCE CLAIMS

Background: The Patient Injury Act has been in effect in Finland since 1 May 1987. This legislation is a no-fault compensation scheme and im plies that if a patient during the course of medical treatment suffers any injury as a result of that treatment he or she may file a claim t o the Patient Insurance Association (PIA). From 1 May 1987 to 31 Decem ber 1993, 23 500 claims for compensation were made. Methods: All claim s made to PIA involving spinal and epidural anaesthesias during the ab ove period were collected and reviewed and a data base was prepared. T he total number of anaesthetics given during this period was estimated by sending questionnaires to every hospital in the country. Results: Eighty-six claims were associated with spinal and/or epidural anaesthe sia. Respectively, the total the number of spinal and epidural anaesth esias administered was 550 000 and 170 000. There were 25 serious comp lications associated with spinal anaesthesia: cardiac arrests (2), par aplegia (5), permanent cauda equina syndrome (1), peroneal nerve pares is (6), neurological deficits (7), and bacterial infections (4). The 9 serious complications which were associated with epidural anaesthesia were: paraparesis (1), permanent cauda equina syndrome (1), peroneal nerve paresis (1), neurological deficit (1), bacterial infections (2), acute toxic reactions related to the anaesthetic solution (2), and ov erdose of epidural opioid (1). Conclusions: According to this material the incidence of serious complications was 0.45:10 000 following spin al and 0.52:10 000 following epidural anaesthesia. Atraumatic techniqu e, careful patient selection and early diagnosis and treatment of comp lications are essential in avoiding permanent injury. (C) Acta Annesth esiologica Scandinavica 41 (1997).