Pediatric Regional Anesthesia Network (PRAN): a multi-institutional study of the use and incidence of complications of pediatric regional anesthesia.
BACKGROUND
Regional anesthesia is increasingly used in pediatric patients to provide postoperative analgesia and to supplement intraoperative anesthesia. The Pediatric Regional Anesthesia Network was formed to obtain highly audited data on practice patterns and complications and to facilitate collaborative research in regional anesthetic techniques in infants and children.


METHODS
We constructed a centralized database to collect detailed prospective data on all regional anesthetics performed by anesthesiologists at the participating centers. Data were uploaded via a secure Internet connection to a central server. Data were rigorously audited for accuracy and errors were corrected. All anesthetic records were scrutinized to ensure that every block that was performed was captured in the database. Intraoperative and postoperative complications were tracked until their resolution. Blocks were categorized by type and as single-injection or catheter (continuous) blocks.


RESULTS
A total of 14,917 regional blocks, performed on 13,725 patients, were accrued from April 1, 2007 through March 31, 2010. There were no deaths or complications with sequelae lasting >3 months (95% CI 0-2:10,000). Single-injection blocks had fewer adverse events than continuous blocks, although the most frequent events (33% of all events) in the latter group were catheter-related problems. Ninety-five percent of blocks were placed while patients were under general anesthesia. Single-injection caudal blocks were the most frequently performed (40%), but peripheral nerve blocks were also frequently used (35%), possibly driven by the widespread use of ultrasound (83% of upper extremity and 69% of lower extremity blocks).


CONCLUSIONS
Regional anesthesia in children as commonly performed in the United States has a very low rate of complications, comparable to that seen in the large multicenter European studies. Ultrasound may be increasing the use of peripheral nerve blocks. Multicenter collaborative networks such as the Pediatric Regional Anesthesia Network can facilitate the collection of detailed prospective data for research and quality improvement.
Departments of Anesthesiology and Pediatrics, Children's Hospital Colorado, 13123 East 16th Ave., B090, Aurora, CO 80045, USA. david.polaner@ucdenver.edu
David M
DM
Polaner
Andreas H
AH
Taenzer
Benjamin J
BJ
Walker
Adrian
A
Bosenberg
Elliot J
EJ
Krane
Santhanam
S
Suresh
Christine
C
Wolf
Lynn D
LD
Martin
D000293:Adolescent; D000765:Anesthesia, Conduction / Q000009:adverse effects* / Q000706:statistics & numerical data*; D000779:Anesthetics, Local / Q000008:administration & dosage / Q000627:therapeutic use; D002404:Catheterization; D002648:Child; D002675:Child, Preschool; D003625:Data Collection; D016208:Databases, Factual / Q000592:standards; D003710:Demography; D004363:Drug Utilization; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007431:Intraoperative Complications / Q000453:epidemiology*; D035002:Lower Extremity; D008297:Male; D009407:Nerve Block / Q000009:adverse effects / Q000706:statistics & numerical data; D011183:Postoperative Complications / Q000453:epidemiology*; D011446:Prospective Studies; D013909:Thorax; D014481:United States / Q000453:epidemiology; D034941:Upper Extremity
D000779:Anesthetics, Local