Benjamin J Walker1, Justin B Long, Madhankumar Sathyamoorthy, Jennifer Birstler, Christine Wolf, Adrian T Bosenberg, Sean H Flack, Elliot J Krane, Navil F Sethna, Santhanam Suresh, Andreas H Taenzer, David M Polaner, Lynn Martin, Corrie Anderson, Rani Sunder, Trevor Adams, Lizabeth Martin, Martha Pankovich, Amod Sawardekar, Patrick Birmingham, Ryan Marcelino, R J Ramarmurthi, Peter Szmuk, Galit Kastner Ungar, Sara Lozano, Karen Boretsky, Ranu Jain, Maria Matuszczak, Timothy R Petersen, Jennifer Dillow, Robert Power, Kim Nguyen, Benjamin H Lee, Lisa Chan, Jorge Pineda, Jacob Hutchins, Kimberly Mendoza, Kristen Spisak, Aali Shah, Kathryn DelPizzo, Naomi Dong, Vidya Yalamanchili, Claudia Venable, Cassandra Armstead Williams, Reena Chaudahari, Susumu Ohkawa, Helga Usljebrka, Tarun Bhalla, Pedro Paulo Vanzillotta, Seza Apiliogullari, Andrew D Franklin, Akiko Ando, Sophie R Pestieau, Caroline Wright, Julia Rosenbloom, Tony Anderson. 1. From the Departments of Anesthesiology (B.J.W.) 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.) 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.
Abstract
WHAT WE ALREADY KNOW ABOUT THIS TOPIC: WHAT THIS ARTICLE TELLS US THAT IS NEW: 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.
WHAT WE ALREADY KNOW ABOUT THIS TOPIC: WHAT THIS ARTICLE TELLS US THAT IS NEW: 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.
Authors: Michael R King; Elizabeth De Souza; Julia M Rosenbloom; Ellen Wang; T Anthony Anderson Journal: Anesth Analg Date: 2020-07 Impact factor: 5.108
Authors: Margaret Ekstein; Avi A Weinbroum; Jacob Ben-Chaim; Eyal Amar; Reut Schvartz; Yifat Klein; Yuval Bar-Yosef Journal: Front Pediatr Date: 2021-03-26 Impact factor: 3.418