Technical aspects and postoperative sequelae of spinal and epidural anesthesia: A prospective study of 3,230 orthopedic patients

Background and Objectives: Major complications after spinal or epidural ane sthesia are extremely rare. The occurrence of less serious and transient se quelae and complaints may be underestimated if there is no established orga nization for the systematic and continuous surveillance of patients after a nesthesia. This study was designed to evaluate the possible relationship be tween various block-related occurrences and the intra- and postoperative si de effects and complaints. Methods: This prospective study included 3,230 orthopedic patients operated on under neuraxial block. The block :vas performed by single-dose (single- shot spinal anesthesia [SPIN], 80.6%), continuous spinal anesthesia (CSA, 1 0.3%). or combined spinal and epidural anesthesia (CSE, 9.1%) technique. Th e patient position during surgery and a detailed description of block perfo rmance and equipment, as well as all intraoperative problems, were immediat ely recorded. Every patient was given a standardized questionnaire to be co mpleted and returned after 1 week. Results: The overall incidence of paresthesia was 12.8%, being most frequen t during spinal catheter insertion with multiple attempts. Postoperative se nsory disturbances (numbness, dysesthesia) occurred unrelated to paresthesi a elicited by the puncture or catheterization. The failure rates (SPIN, 1.0 %; CSA, 1.5%; and CSE, 1.0%) were quite low. Asystole with successful resus citation, occurred in 1 patient with CSE but, overall, hemodynamic perturba tions were more common with the continuous techniques. On the first postope rative day, decreased sensation of the skin was significantly more frequent after the continuous techniques, still present in 6.5% of SPIN patients. 6 .1% of CSA patients, and 17.2% of CSE patients I week after surgery. These disturbances were also related to the use of a tourniquet and lateral posit ion of the patient during surgery. The frequency of postdural puncture head ache (PDPH) was similar for the different techniques (SPM, 0.9%; CSA, 1.5%: and CSE, 1.7%). About one third of the patients reported strong postoperat ive pain on the day after the operation, and 5.6% continued to report this at 1 week. Conclusions: Although sensory changes were quite frequent, they were mild a nd transient. Rather than having been caused by the anesthetic technique, p er se, a "nonanesthetic" reason (position, tourniquet, immobilization) shou ld also he considered as their origin. Sensory disturbances, as well as str ong pain for at least a week, were reported by several patients, and to bec ome aware of these problems and improve the quality of treatment, a univers al regional anesthesia follow-up system is recommended.