Department of Dermatology, Seoul National University Hospital, Seoul, South Korea.
Department of Medical Law and Ethics, Graduate School, Yonsei University, Seoul, South Korea.
Reg Anesth Pain Med. 2020 May;45(5):337-343. doi: 10.1136/rapm-2019-101169. Epub 2020 Feb 28.
Although there is a low incidence of complications associated with epidural injections, pain physicians should still remain vigilant for potentially serious adverse outcomes. This study aimed to identify and describe the major complications of epidural injections.
This retrospective, observational, medicolegal study analyzed closed cases of precedents involving complications of epidural injections from January 1997 to August 2019 using the database of the Supreme Court of Korea's judgement system. Clinical characteristics and judgement statuses were analyzed.
Of the 73 potential cases assessed for eligibility, a total of 49 malpractice cases were included in the final analysis. Thirty-three claims resulted in payments to the plaintiffs, with a median payment of US$103 828 (IQR: US$45 291-US$265 341). The most common complication was infection (n=13, 26.5%), followed by worsening pain (n=8, 16.3%). Physician malpractice before, during, and after the procedure was claimed by plaintiffs in 18 (36.7%), 44 (89.8%), and 31 (63.3%) cases, respectively. Of these cases, 6 (33.3%), 19 (43.2%), and 15 (48.4%), respectively, were adjudicated in favor of the plaintiffs by the courts. In cases involving postprocedural physician errors, the majority (13/15) of the plaintiff verdicts were related to delayed management. Violation of the physician's duty of informed consent was claimed by plaintiffs in 31 (63.3%) cases, and 14 (45.2%) of these cases were judged medical malpractice.
Our data will allow pain physicians to become acquainted with the major epidural injection-associated complications that underlie malpractice cases.
虽然硬膜外注射相关并发症的发生率较低，但疼痛医师仍应保持警惕，以防发生潜在的严重不良后果。本研究旨在确定和描述硬膜外注射的主要并发症。
本回顾性、观察性、法医学研究使用韩国最高法院判决系统的数据库，分析了 1997 年 1 月至 2019 年 8 月期间涉及硬膜外注射并发症的已决案例的封闭案例。分析了临床特征和判决状况。
在评估的 73 个潜在案例中，共有 49 个医疗事故案例符合最终分析标准。33 项索赔导致向原告支付赔偿金，中位数为 103828 美元（IQR：45291-265341 美元）。最常见的并发症是感染（n=13，26.5%），其次是疼痛恶化（n=8，16.3%）。原告分别在术前、术中和术后声称医生存在医疗事故 18（36.7%）、44（89.8%）和 31（63.3%）例。其中，6（33.3%）、19（43.2%）和 15（48.4%）例被法庭判决有利于原告。在涉及术后医生失误的案例中，大多数（13/15）的原告裁决都与延迟管理有关。原告在 31（63.3%）例中声称医生违反了知情同意的义务，其中 14（45.2%）例被判定为医疗事故。
我们的数据将使疼痛医师了解导致医疗事故的主要硬膜外注射相关并发症。
