Major complications with epidural and spinal anaesthesia are very uncommon, according to UK researchers who analysed data from The Royal College of Anaesthetists Third National Audit Project.

“The report is probably the most robust report to date on this subject,” lead author Dr Tim M. Cook from Royal United Hospital, Bath, UK, said. “The risk of major complications... is lower than most previous estimates.”

Dr Cook and his colleagues sought first to determine the annual number of epidural and spinal anaesthesia procedures in the UK and then to audit major complications over a 12-month period.

According to their report in the British Journal of Anaesthesia, the investigators identified just over 700,000 procedures, most of which were performed for obstetric (45 per cent) or surgical reasons (44 per cent).

Fifty-two cases met the criteria for major complications and were followed for a minimum of six months. Twenty-two of these patients made fully documented complete recoveries.

Sixteen of the remaining 30 patients were expected to make a good recovery, the researchers note, leaving 14 patients likely to have experienced permanent harm.

Based on these figures, the rate of any permanent injury ranged from 2.0 to 4.2 injuries per 100,000 cases. The rate of death or paraplegia was between 0.7 and 1.8 per 100,000 cases.

Complications were most common after surgical use.

Although the findings are encouraging, Dr Cook emphasised that “avoidable injury probably still occurs and may be reduced by (doctors following) previously published recommendations.”

Reuters Health

Source: British Journal of Anaesthesia, February 2009