Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1016/j.bjane.2021.03.011
Brazilian Journal of Anesthesiology
Original Investigation

Assessment of main complications of regional anesthesia recorded in an acute pain unit in a tertiary care university hospital: a retrospective cohort

Avaliação das principais complicações da anestesia regional registradas em uma unidade de dor aguda em um hospital universitário terciário: uma coorte retrospectiva

Marta G. Campos, Ana R. Peixoto, Sara Fonseca, Francisca Santos, Cristiana Pinho, Diana Leite

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Abstract

Background
Regional anesthesia has been increasingly used. Despite its low number of complications, they are associated with relevant morbidity. This study aims to evaluate the incidence of complications after neuraxial block and peripheral nerve block.

Methods
A retrospective cohort study was conducted, and data related to patients submitted to neuraxial block and peripheral nerve block at a tertiary university hospital from January 1, 2011 to December 31, 2017 were analyzed.

Results
From 10,838 patients referred to Acute Pain Unit, 1093(10.1%) had side effects or complications: 1039 (11.4%) submitted to neuraxial block and 54 (5.2%) to peripheral nerve block. The most common side effects after neuraxial block were sensory (48.5%) or motor deficits (11.8%), nausea or vomiting (17.5%) and pruritus (8.0%); The most common complications: 3 (0.03%) subcutaneous cell tissue hematoma, 3 (0.03%) epidural abscesses and 1 (0.01%) arachnoiditis. 204 of these patients presented sensory or motor deficits at hospital discharge and needed follow-up. Permanent peripheral nerve injury after neuraxial block had an incidence of 7.7:10,000 (0.08%). The most common side effects after peripheral nerve block were sensory deficits (52%) and 21 patients maintained follow-up due to symptoms persistence after hospital discharge.

Conclusion
Although we found similar incidences of side effects or even lower than those described, major complications after neuraxial block had a higher incidence, particularly epidural abscesses. Despite this, other serious complications, such as spinal hematoma and permanent peripheral nerve injury, are still rare.

Keywords

Anesthesia and Analgesia,  Anesthesia, Epidural,  Anesthesia, Spinal,  Nerve Block

Resumo

Introdução: A anestesia regional tem sido cada vez mais utilizada. Apesar do baixo número de complicações, estão associadas a morbidade relevante. Este estudo tem como objetivo avaliar a incidência de complicações após bloqueio neuroaxial e bloqueio de nervo periférico. Métodos: Foi realizado um estudo de coorte retrospectivo e analisados os dados referentes aos pacientes submetidos a bloqueio neuroaxial e bloqueio de nervo periférico em um hospital universitário terciário no período de 1º de janeiro de 2011 a 31 de dezembro de 2017. Resultados: Dos 10.838 pacientes encaminhados à Unidade de Dor Aguda, 1.093 (10,1%) apresentaram efeitos colaterais ou complicações: 1.039 (11,4%) submetidos ao bloqueio neuroaxia e 54 (5,2%) ao bloqueio de nervo periférico. Os efeitos colaterais mais comuns após o bloqueio neuroaxial foram déficits sensoriais (48,5%) ou motores (11,8%), náuseas ou vômitos (17,5%) e prurido (8,0%); As complicações mais comuns: 3 (0,03%) hematoma de tecido celular subcutâneo, 3 (0,03%) abscessos epidurais e 1 (0,01%) aracnoidite. 204 desses pacientes apresentaram déficits sensoriais ou motores na alta hospitalar e necessitaram de acompanhamento. A lesão permanente de nervo periférico após bloqueio neuroaxial teve incidência de 7,7:10.000 (0,08%). Os efeitos colaterais mais comuns após bloqueio do nervo periférico foram déficits sensoriais (52%) e 21 pacientes mantiveram o acompanhamento devido à persistência dos sintomas após a alta hospitalar. Conclusão: Embora tenhamos encontrado incidências de efeitos colaterais semelhantes ou até inferiores às descritas, as complicações maiores após o bloqueio neuroaxial tiveram maior incidência, principalmente de abscessos epidurais. Apesar disso, outras complicações graves, como hematoma espinhal e lesão permanente de nervo periférico, ainda são raras.

Palavras-chave

Anestesia e Analgesia; Anestesia Peridural; Anestesia Espinhal; Bloqueio de nervo

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