Department of Anesthesia and Pain Medicine, The Hospital for Sick Children, University of Toronto, 555 University Avenue, Toronto, ON, M5G 1X8, Canada.
Can J Anaesth. 2013 Apr;60(4):355-63. doi: 10.1007/s12630-012-9877-3. Epub 2013 Jan 8.
Complications associated with epidural analgesia in children have a reported incidence of 40-90 in 10,000 epidurals. We sought to determine the incidence of major complications with the use of continuous epidural analgesia that occurred in our centre over the past 15 years and to describe the nature of these complications.
The Acute Pain Service database at a tertiary care academic pediatric hospital was reviewed retrospectively over a 15-year period. Data were categorized according to patient age (neonate, infant, child one through eight years, and child > eight years), mode of insertion of the epidural (caudal, transsacral, lumbar, thoracic), complication type, and complication severity.
Over the 15-year period, 3,152 epidurals were performed. The use of caudal-thoracic epidurals in neonates and infants has increased since 2007. Twenty-four major complications were identified (incidence, 7.6 in 1,000 epidurals). The rate of complications in neonates was 4.2% compared with 1.4% in infants, 0.5% in children aged one through eight years, and 0.8% in children over eight years of age. The two most common complications were local skin infection and drug error.
Our incidence of major complications and our finding that complications were more common in neonates and infants are both consistent with previously published data. The two most common types of complications are potentially preventable.
儿童硬膜外镇痛相关并发症的发生率为每 10000 例硬膜外镇痛中有 40-90 例。我们旨在确定过去 15 年来在我们中心使用连续硬膜外镇痛时发生的主要并发症的发生率，并描述这些并发症的性质。
回顾性分析一家三级保健学术儿科医院的急性疼痛服务数据库，时间跨度为 15 年。根据患者年龄（新生儿、婴儿、1 至 8 岁儿童和>8 岁儿童）、硬膜外插入方式（骶骨、经骶骨、腰椎、胸椎）、并发症类型和并发症严重程度对数据进行分类。
在 15 年期间，共进行了 3152 例硬膜外。自 2007 年以来，新生儿和婴儿中使用骶骨-胸段硬膜外的情况有所增加。共发现 24 例主要并发症（发生率为每 1000 例硬膜外镇痛中 7.6 例）。新生儿并发症发生率为 4.2%，婴儿为 1.4%，1 至 8 岁儿童为 0.5%，>8 岁儿童为 0.8%。最常见的两种并发症是局部皮肤感染和药物错误。
我们的主要并发症发生率以及我们发现并发症在新生儿和婴儿中更为常见的结果与先前发表的数据一致。两种最常见的并发症是潜在可预防的。
