The national pediatric epidural audit.

BACKGROUND

This paper describes a prospective audit of children receiving epidural infusion analgesia (EIA) in Great Britain and Ireland. The aim was to quantify the risks associated with this technique.

METHODS

In order to obtain sufficient data on the number of pediatric epidurals performed and the incidence of unwanted events, a decision was taken, at an Annual Meeting of Great Britain and Ireland Paediatric Pain Services, to establish a national audit of EIA practice in these centers. Each site sent a monthly return of the numbers of EIA performed to the coordinating center. If an incident occurred then the referring site completed a more detailed form and the child was followed up for 1 year if possible. Incidents were graded by severity 13, serious to minor. These data were collected over the 5-year period (2001-2005).

RESULTS

(i) Ninety six incidents were reported in 10 633 epidurals performed. (ii) Fifty six were associated with the insertion or maintenance of EIA; most were of low severity (1 : 189). (iii) Five incidents were graded as 1 (serious) (approximately 1 : 2000). (iv) Nine incidents were graded as 2 (approximately 1 : 1100). (v) Only one child has residual effects from a grade 1 incident 12 months after surgery (approximately 1 : 10 000). (vi) Forty incidents were also reported that were felt to be associated with the use of EIA; 33 of these incidents were the development of pressures sores. Four incidents of compartment syndrome were reported, in each of these cases the presence of EIA did not mask the condition.

CONCLUSIONS

Epidural infusion analgesia in children does have risks associated with the technique. The occurrence of compartment syndrome does not appear to be masked by the presence of working EIA. As a result of this audit we can now provide parents with better information, thereby improving the process of informed consent.