Newly Published
Perioperative Medicine  |   August 2018
Complications in Pediatric Regional Anesthesia: An Analysis of More than 100,000 Blocks from the Pediatric Regional Anesthesia Network
Author Notes
  • From the Departments of Anesthesiology (B.J.W.) and Biostatistics and Medical Informatics (J.B.), University of Wisconsin School of Medicine and Public Health, American Family Children’s Hospital, Madison, Wisconsin; the Department of Anesthesiology, Emory University School of Medicine, Children’s Healthcare of Atlanta at Egleston Children’s Hospital, Atlanta, Georgia (J.B.L.); the Department of Anesthesiology, University of Mississippi Medical Center, Jackson, Mississippi (M.S.); Axio Research LLC, Seattle, Washington (C.W.); the Department of Anesthesiology and Pain Medicine, University of Washington School of Medicine, Seattle Children’s Hospital, Seattle, Washington (A.T.B., S.H.F.); the Departments of Pediatrics and Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California, Lucile Packard Children’s Hospital, Palo Alto, California (E.J.K.); the Department of Anesthesiology, Harvard Medical School, Boston Children’s Hospital, Boston, Massachusetts (N.F.S.); the Department of Pediatric Anesthesiology, Ann and Robert H. Lurie Children’s Hospital of Chicago, Northwestern University, Chicago, Illinois (S.S.); the Departments of Anesthesiology and Pediatrics, Dartmouth Medical School, Children’s Hospital at Dartmouth, Lebanon, New Hampshire (A.H.T.); and the Departments of Anesthesiology and Pediatrics, University of Colorado School of Medicine, Children’s Hospital Colorado, Aurora, Colorado (D.M.P.).,
  • Seattle Children’s Hospital
  • Seattle Children’s Hospital
  • Seattle Children’s Hospital
  • Seattle Children’s Hospital
  • Seattle Children’s Hospital
  • Seattle Children’s Hospital
  • Lurie Children’s Hospital, Northwestern University
  • Lurie Children’s Hospital, Northwestern University
  • Lurie Children’s Hospital, Northwestern University
  • Lucile Packard Children’s Hospital at Stanford
  • Children’s Medical Center, Dallas
  • Children’s Medical Center, Dallas
  • The Cleveland Clinic
  • Boston Children’s Hospital
  • University of Texas, Houston
  • University of Texas, Houston
  • University of New Mexico
  • University of New Mexico
  • Texas Children’s Hospital
  • Texas Children’s Hospital
  • Texas Children’s Hospital
  • Texas Children’s Hospital
  • Doernbecher Children’s Hospital, Oregon Health Sciences University
  • Amplatz Children’s Hospital/University of Minnesota
  • Amplatz Children’s Hospital/University of Minnesota
  • Riley Hospital for Children at Indiana University Health
  • Riley Hospital for Children at Indiana University Health
  • Hospital for Special Surgery, New York
  • Hospital for Special Surgery, New York
  • Children’s Healthcare of Atlanta at Egleston Children’s Hospital, Emory University
  • Children’s Healthcare of Atlanta at Egleston Children’s Hospital, Emory University
  • Children’s of Mississippi, University of Mississippi
  • Joe DiMaggio Children’s Hospital
  • Columbia University
  • University Hospital Rijeka, Croatia
  • Nationwide Children’s Hospital, Ohio State University
  • Hospital Municipal Jesus, Rio De Janiero, Brazil
  • Selçuk University, Konya, Turkey
  • Monroe Carrell Children’s Hospital, Vanderbilt University
  • Wellstar Medical Group
  • Children’s National Medical Center
  • Children’s National Medical Center
  • Massachusetts General Hospital for Children
  • Massachusetts General Hospital for Children
  • Submitted for publication September 19, 2017. Accepted for publication June 19, 2018.
    Submitted for publication September 19, 2017. Accepted for publication June 19, 2018.×
  • Research Support: Supported by the Mayday Fund and departmental funding from the participating institutions.
    Research Support: Supported by the Mayday Fund and departmental funding from the participating institutions.×
  • Competing Interests: The authors declare no competing interests.
    Competing Interests: The authors declare no competing interests.×
  • Correspondence: Address correspondence to Dr. Walker: B6/319 CSC, 600 Highland Avenue, Madison, Wisconsin 53792. bjwalker2@wisc.edu. Information on purchasing reprints may be found at www.anesthesiology.org or on the masthead page at the beginning of this issue. Anesthesiology’s articles are made freely accessible to all readers, for personal use only, 6 months from the cover date of the issue.
  • Preliminary results of this analysis were presented on October 24, 2016, at the meeting of the American Society of Anesthesiologists, Chicago, Illinois.
    Preliminary results of this analysis were presented on October 24, 2016, at the meeting of the American Society of Anesthesiologists, Chicago, Illinois.×
  • *Members of the Pediatric Regional Anesthesia Network Investigators are listed in the appendix.
    Members of the Pediatric Regional Anesthesia Network Investigators are listed in the appendix.×
  • *No longer a Pediatric Regional Anesthesia Network member but contributed data included in this analysis.
    No longer a Pediatric Regional Anesthesia Network member but contributed data included in this analysis.×
  • Current Pediatric Regional Anesthesia Network member but joined after data collection period.
    Current Pediatric Regional Anesthesia Network member but joined after data collection period.×
Article Information
Perioperative Medicine / Pediatric Anesthesia / Regional Anesthesia
Perioperative Medicine   |   August 2018
Complications in Pediatric Regional Anesthesia: An Analysis of More than 100,000 Blocks from the Pediatric Regional Anesthesia Network
Anesthesiology Newly Published on August 2, 2018. doi:10.1097/ALN.0000000000002372
Anesthesiology Newly Published on August 2, 2018. doi:10.1097/ALN.0000000000002372
Abstract

What We Already Know about This Topic:

  • Regional anesthesia is associated with a low but poorly quantified incidence of complications.

What This Article Tells Us That Is New:

  • In a prospective multicenter cohort of more than 100,000 blocks in children, there were no cases of permanent neurologic deficit associated with regional anesthesia. The rate of transient neurologic deficit was low at 2.4 per 10,000, and the incidence of local anesthesia toxicity was also low at 0.76 per 10,000.

Background: Complications in pediatric regional anesthesia are rare, so a large sample size is necessary to quantify risk. The Pediatric Regional Anesthesia Network contains data on more than 100,000 blocks administered at more than 20 children’s hospitals. This study analyzed the risk of major complications associated with regional anesthesia in children.

Methods: This is a prospective, observational study of routine clinical practice. Data were collected on every regional block placed by an anesthesiologist at participating institutions and were uploaded to a secure database. The data were audited at multiple points for accuracy.

Results: There were no permanent neurologic deficits reported (95% CI, 0 to 0.4:10,000). The risk of transient neurologic deficit was 2.4:10,000 (95% CI, 1.6 to 3.6:10,000) and was not different between peripheral and neuraxial blocks. The risk of severe local anesthetic systemic toxicity was 0.76:10,000 (95% CI, 0.3 to 1.6:10,000); the majority of cases occurred in infants. There was one epidural abscess reported (0.76:10,000, 95% CI, 0 to 4.8:10,000). The incidence of cutaneous infections was 0.5% (53:10,000, 95% CI, 43 to 64:10,000). There were no hematomas associated with neuraxial catheters (95% CI, 0 to 3.5:10,000), but one epidural hematoma occurred with a paravertebral catheter. No additional risk was observed with placing blocks under general anesthesia. The most common adverse events were benign catheter-related failures (4%).

Conclusions: The data from this study demonstrate a level of safety in pediatric regional anesthesia that is comparable to adult practice and confirms the safety of placing blocks under general anesthesia in children.