title: Major complications related to epidural analgesia in children: a 15-year audit of 3,152 epidurals.
abstract: BACKGROUND
  Complications associated with epidural analgesia in children have a reported incidence of 40-90 in 10,000 epidurals. We sought to determine the incidence of major complications with the use of continuous epidural analgesia that occurred in our centre over the past 15 years and to describe the nature of these complications.
  
  
  METHODS
  The Acute Pain Service database at a tertiary care academic pediatric hospital was reviewed retrospectively over a 15-year period. Data were categorized according to patient age (neonate, infant, child one through eight years, and child > eight years), mode of insertion of the epidural (caudal, transsacral, lumbar, thoracic), complication type, and complication severity.
  
  
  RESULTS
  Over the 15-year period, 3,152 epidurals were performed. The use of caudal-thoracic epidurals in neonates and infants has increased since 2007. Twenty-four major complications were identified (incidence, 7.6 in 1,000 epidurals). The rate of complications in neonates was 4.2% compared with 1.4% in infants, 0.5% in children aged one through eight years, and 0.8% in children over eight years of age. The two most common complications were local skin infection and drug error.
  
  
  CONCLUSIONS
  Our incidence of major complications and our finding that complications were more common in neonates and infants are both consistent with previously published data. The two most common types of complications are potentially preventable.
authors.affiliation: Department of Anesthesia and Pain Medicine, The Hospital for Sick Children, University of Toronto, 555 University Avenue, Toronto, ON, M5G 1X8, Canada. gail.wong@sickkids.ca
authors.forename: Gail K
authors.initials: GK
authors.lastname: Wong
authors.forename: Abeer A
authors.initials: AA
authors.lastname: Arab
authors.forename: Sue C
authors.initials: SC
authors.lastname: Chew
authors.forename: Basem
authors.initials: B
authors.lastname: Naser
authors.forename: Mark W
authors.initials: MW
authors.lastname: Crawford
mesh_terms: D000367:Age Factors; D015360:Analgesia, Epidural / Q000009:adverse effects* / Q000379:methods; D002648:Child; D002675:Child, Preschool; D006776:Hospitals, Pediatric; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D008508:Medication Errors / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012720:Severity of Illness Index; D012874:Skin Diseases, Infectious / Q000453:epidemiology / Q000209:etiology*; D013904:Thoracic Vertebrae