Serious complications related to regional anesthesia - Results of a prospective survey in France
Serious complications related to regional anesthesia - Results of a prospective survey in France
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DOI：
10.1097/00000542-199709000-00005
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发表时间：
1997-09-01
期刊：
影响因子：
8.8
通讯作者：
Samii, K
中科院分区：
文献类型：
--
作者：
Auroy, Y;Narchi, P;Samii, K
背景：以前主要在病例报告和回顾性调查中描述了与区域麻醉相关的严重并发症。作者前瞻性地评估了一系列多中心的区域麻醉剂，使用预先计划的标准来衡量相关严重并发症的发生率和特征。方法：在随后5个月的研究期之前，向4,927名法国麻醉师发送请求。参与研究的麻醉师被要求详细报告在他们进行区域麻醉期间或之后发生的严重并发症。然后通过第二次问卷调查获得每个并发症的详细信息。结果：麻醉医师总人数为736人。实施区域麻醉103,730例，其中脊髓麻醉40,640例，硬膜外麻醉30,413例，周围神经阻滞21,278例，静脉区域麻醉11,229例。共收到98例严重并发症报告，其中97例获得随访资料。89例并发症全部或部分归因于区域麻醉。在研究期间发生了32例心脏骤停，其中7例是致命的。其中，脊髓麻醉时发生26例，其中6例死亡，硬膜外麻醉时发生3例，外周阻滞时发生3例。与其他区域麻醉（1.0 +/- 0.4 /万）相比，脊髓麻醉期间心脏骤停的发生率（6.4 +/- 1.2 /万）较高（P < 0.05）。在34例神经系统并发症（神经根病、马尾综合征、截瘫）中，21例与穿刺时感觉异常（n = 19）或注射时疼痛（n = 2）相关，提示神经损伤或神经内注射。12例脊髓麻醉后出现神经系统并发症的患者在置针时无感觉异常，注射时无疼痛。在这12例患者中（7例神经根病，5例马尾综合征），9例鞘内高压氧利多卡因，5%。脊髓麻醉后的神经损伤发生率（6 +/- 1 / 10000例，P < 0.05）明显高于其他区域手术后的发生率（加权平均值为1.6 +/- 0.5 / 10000例）。23例患者因局麻药血清水平升高引起癫痫发作，但没有一例发生心脏骤停。结论：(1)与区域麻醉相关的心脏骤停和神经损伤发生率很低，但脊髓麻醉后两者均比其他区域麻醉后高3个SDs以上。(2)三分之二的神经功能缺损患者在放针时感觉异常或注射时疼痛。(3)非创伤性脊髓麻醉后75%的神经功能缺损发生在接受高压氧利多卡因的患者中，5%发生在接受高压氧利多卡因的患者中。
Background: Serious complications related to regional anesthesia have previously been described primarily in case reports and retrospective surveys. The authors prospectively evaluated a multicenter series of regional anesthetics, using preplanned criteria to measure the incidence and characteristics of associated serious complications.Methods: Requests were sent to 4,927 French anesthesiologists in advance of a subsequent 5-month study period. Participating anesthesiologists were asked for detailed reports of serious complications occurring during or after regional anesthetics performed by them during the study interval. Details regarding each complication then were obtained via a second questionnaire.Results: The number of responding anesthesiologists was 736. The number of regional anesthetics performed was 103,730, corresponding to 40,640 spinal anesthetics, 30,413 epidural anesthetics, 21,278 peripheral nerve blocks, and 11,229 intravenous regional anesthetics. Reports of 98 severe complications were received, with follow-up information being obtained for 97. In 89 cases, complications were attributed fully or partially to regional anesthesia. Thirty-two cardiac arrests, seven of which were fatal, occurred during the study. Of these, 26 occurred during spinal anesthesia, with 6 being fatal, 3 occurred during epidural anesthesia, and 3 more occurred during peripheral blocks. The higher incidence of cardiac arrest during spinal anesthesia (6.4 +/- 1.2 per 10,000 patients) compared with all other regional anesthesia (1.0 +/- 0.4 per 10,000 patients) was statistically significant (P < 0.05). Of 34 neurologic complications (radiculopathy, cauda equina syndrome, paraplegia), 21 were associated either with paresthesia during puncture (n = 19) or with pain during injection (n = 2), suggesting nerve trauma or intraneural injection. Twelve patients who had neurologic complications after spinal anesthetics had no paresthesia during needle placement and no pain on injection. Of these 12 patients (7 with radiculopathy and 5 with cauda equina syndrome), 9 received intrathecal hyperbaric lidocaine, 5%. The incidence of neurologic injury was significantly greater after spinal anesthesia (6 +/- 1 per 10,000 cases; P < 0.05) than after each of the other types of regional procedures (1.6 +/- 0.5 per 10,000 cases for the weighted average). Seizures attributed to elevated serum levels of local anesthetics occurred in 23 patients, but none suffered a cardiac arrest.Conclusions: (1) The incidence of cardiac arrest and neurologic injury related to regional anesthesia were very low, but both were more than three SDs greater after spinal anesthesia than after other regional procedures. (2) Two thirds of the patients with neurologic deficits had either-a paresthesia during needle placement or pain on injection. (3) Seventy-five percent of the neurologic deficits after nontraumatic spinal anesthesia occurred in patients who had received hyperbaric lidocaine, 5%.