title: Major complications of epidural analgesia after surgery: results of a six-year survey.
abstract: We performed a retrospective case note review to identify the major complications of epidural analgesia occurring after surgery at our hospital. By cross-referencing the radiology, microbiology and patient information management system databases, we identified patients who had undergone either spinal magnetic resonance imaging or a lumbar puncture within 60 days of surgery in the period from January 2000 to December 2005. Review of these case notes identified six cases of epidural abscess, three of meningitis and three of epidural haematoma. Symptoms of epidural abscess or meningitis developed a median of 5 days after epidural catheter removal. Methicillin-resistant Staphylococcus aureus was the predominant pathogen. Epidural haematoma symptoms developed while the epidural catheter was in place. These symptoms were initially attributed to the epidural infusion. Diagnostic delays contributed to adverse neurological outcome in three patients. This study suggests that leg weakness is a critical monitor of spinal cord health. A national database is needed to establish a more accurate estimate of the incidence of major complications and to identify relevant risk factors.
authors: Department of Anaesthesia, Derriford Hospital, Plymouth, PL6 8DH, UK. iain.christie@phnt.swest.nhs.uk
authors: I W
authors: IW
authors: Christie
authors: S
authors: S
authors: McCabe
mesh_terms: D000465:Algorithms; D015360:Analgesia, Epidural / Q000009:adverse effects* / Q000379:methods; D003428:Cross Infection / Q000175:diagnosis / Q000209:etiology / Q000628:therapy; D020802:Epidural Abscess / Q000175:diagnosis / Q000209:etiology / Q000628:therapy; D046748:Hematoma, Epidural, Spinal / Q000175:diagnosis / Q000209:etiology / Q000628:therapy; D006801:Humans; D007866:Leg / Q000503:physiopathology; D008279:Magnetic Resonance Imaging; D016920:Meningitis, Bacterial / Q000175:diagnosis / Q000209:etiology / Q000628:therapy; D016106:Methicillin Resistance; D018908:Muscle Weakness / Q000209:etiology; D010149:Postoperative Pain / Q000628:therapy*; D011182:Postoperative Care / Q000009:adverse effects / Q000379:methods; D012189:Retrospective Studies; D012307:Risk Factors; D013129:Spinal Puncture; D013203:Staphylococcal Infections / Q000209:etiology