[Complications and adverse events in continuous peripheral regional anesthesia Results of investigations on 3,491 catheters]

Abstract

Introduction: Over a period of 36 months we prospectively documented infectious, neurological and other complications or adverse events occurring during 3,491 peripheral regional anesthesias via a catheter using computer-based data recording.

Methods: The investigation included 936 axillar plexus catheters, 473 interscalene plexus catheters, 125 vertical infraclavicular plexus catheters, 74 catheters with psoas compartment blocks, 900 femoral nerve catheters, 964 sciatic nerve catheters and 19 catheters in other localizations. The regional anesthesia catheters were inserted under sterile circumstances (hood, facemask, sterile gloves and coat, surgical disinfection and sterile covering of the placement site) and under peripheral nerve stimulation.

Results: 3,070 (87.9%) of the regional anesthesias via catheter, were carried out without any complications. Inflammation (two out of three criteria: redness at insertion site, pain on palpation or swelling) was found in 146 patients (4.2% of all cases). Infections (two out of the criteria: CRP elevation, pus on the insertion site, fever, leucocytosis, necessary antibiotic treatment with exclusion of other possible causes) appeared in 2.4% of all cases (83 patients). In 29 patients (0.8%) we observed severe infections (surgical intervention necessary e.g. abscess incision). Risk factors for inflammation or infections included duration of catheter therapy, cervical localization of the catheter and the experience of the anesthesiologist (p<0.05). Bacterial species most frequently found were Staphylococcus aureus (54%) and Staphylococcus epidermidis (38%). In 0.3% (9 patients) we found short lasting neurological deficits and in 6 patients (0.2%) we recorded a nerve lesion that lasted more than 6 weeks. Other complications occurred in 4.2% of all cases.

Discussion: Special complications such as infections in peripheral catheter regional anesthesia are rare but can pose severe problems. A close postoperative supervision of all regional catheters has to be ensured under careful consideration of the risk factors for infections and the accompanying symptoms.