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The national pediatric epidural audit
1Acute Pain Service, Birmingham Children's Hospital NHS Trust, Birmingham, UK. dgl_nel@yahoo.co.uk
Insights
Pediatric epidural infusion analgesia (EIA) carries risks, with serious events rare (1:2000). This audit provides data to improve informed consent for parents regarding the safety of epidural analgesia in children.
Area of Science:
- Pediatric Anesthesiology
- Pain Management
- Clinical Audit
Background:
- Prospective audit of pediatric epidural infusion analgesia (EIA) in Great Britain and Ireland.
- Aim: Quantify risks associated with pediatric EIA.
Purpose of the Study:
- To establish a national audit of EIA practice in pediatric pain services.
- To collect data on the number of pediatric epidurals and incidence of adverse events.
Main Methods:
- National audit of EIA practice from 2001-2005.
- Monthly returns of EIA numbers; detailed forms for incidents.
- Incident severity grading (1-3) and 1-year follow-up where possible.
Main Results:
- 96 incidents reported in 10,633 epidurals.
- 5 serious (Grade 1) incidents (approx. 1:2000).
- 1 child with residual effects from a Grade 1 incident (approx. 1:10,000).
- Compartment syndrome not masked by EIA.
Conclusions:
- Pediatric EIA has associated risks, but serious events are infrequent.
- EIA does not mask compartment syndrome.
- Audit data enhances informed consent for parents regarding pediatric epidural analgesia.
Background:
This paper describes a prospective audit of children receiving epidural infusion analgesia (EIA) in Great Britain and Ireland. The aim was to quantify the risks associated with this technique.
Methods:
In order to obtain sufficient data on the number of pediatric epidurals performed and the incidence of unwanted events, a decision was taken, at an Annual Meeting of Great Britain and Ireland Paediatric Pain Services, to establish a national audit of EIA practice in these centers. Each site sent a monthly return of the numbers of EIA performed to the coordinating center. If an incident occurred then the referring site completed a more detailed form and the child was followed up for 1 year if possible. Incidents were graded by severity 13, serious to minor. These data were collected over the 5-year period (2001-2005).
Results:
(i) Ninety six incidents were reported in 10 633 epidurals performed. (ii) Fifty six were associated with the insertion or maintenance of EIA; most were of low severity (1 : 189). (iii) Five incidents were graded as 1 (serious) (approximately 1 : 2000). (iv) Nine incidents were graded as 2 (approximately 1 : 1100). (v) Only one child has residual effects from a grade 1 incident 12 months after surgery (approximately 1 : 10 000). (vi) Forty incidents were also reported that were felt to be associated with the use of EIA; 33 of these incidents were the development of pressures sores. Four incidents of compartment syndrome were reported, in each of these cases the presence of EIA did not mask the condition.
Conclusions:
Epidural infusion analgesia in children does have risks associated with the technique. The occurrence of compartment syndrome does not appear to be masked by the presence of working EIA. As a result of this audit we can now provide parents with better information, thereby improving the process of informed consent.
