Department of Anaesthesiology, Singapore General Hospital, Singapore.
Ann Acad Med Singap. 2017 Jul;46(7):274-281.
The incidence of complications related to epidural analgesia remains less well defined in the paediatric population as compared to adults. A retrospective review of prospectively collected data was performed to review and quantify risks of both adverse events and complications related to epidural analgesia in our Singaporean paediatric population.
Data from the Acute Pain Service (APS) was prospectively collected over 19 years. Details included the age of the patients, level of insertion of the epidural catheter, number of attempts, staff grade of the practitioner, adverse events and complications.
Collectively, 829 epidurals were performed from 1 June 1997 to 31 May 2016. No deaths or major complications occurred within the 16-year period. There were 5 instances of dural puncture (0.6%). The incidence of minor postoperative complications was 3.1% with the majority of postoperative events comprising catheter-related problems (n = 161, 22.4%). Prolonged use of the catheter beyond 3 days is associated with a statistically significant increase in the frequency of skin infective/ inflammatory changes ( <0.01). We highlight common complications and conundrums faced.
Epidural analgesia has been shown to be associated with a relatively low risk of complications both in the adult and paediatric populations, albeit with a fourfold increased risk in the latter cohort. Adverse events reported are largely related to catheter problems and have minimal impact upon the patient.
与成人相比，硬膜外镇痛相关并发症在儿科人群中的发病率定义尚不明确。本研究通过回顾性分析前瞻性收集的数据，旨在评估并量化新加坡儿科人群中硬膜外镇痛相关不良事件和并发症的风险。
19 年来，急性疼痛服务（APS）前瞻性地收集数据。详细信息包括患者年龄、硬膜外导管插入水平、尝试次数、操作者职级、不良事件和并发症。
1997 年 6 月 1 日至 2016 年 5 月 31 日期间，共进行了 829 次硬膜外麻醉。16 年内无死亡或重大并发症发生。发生 5 例硬脊膜穿刺（0.6%）。术后轻微并发症的发生率为 3.1%，大多数术后事件为导管相关问题（n=161，22.4%）。导管使用时间超过 3 天与皮肤感染/炎症变化的频率显著增加相关（<0.01）。我们强调了常见的并发症和难题。
硬膜外镇痛与成人和儿科人群的并发症风险相对较低相关，尽管后者的风险增加了 4 倍。报告的不良事件主要与导管问题有关，对患者的影响很小。
