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. 2020 Sep 10:13:111-119.
doi: 10.2147/LRA.S272410. eCollection 2020.

Postoperative Thoracic Epidural Analgesia: Adverse Events from a Single-Center Series of 3126 Patients

Alberto Manassero  1 , Matteo Bossolasco  1 , Mattia Carrega  1 , Giuseppe Coletta  1
Affiliations

Postoperative Thoracic Epidural Analgesia: Adverse Events from a Single-Center Series of 3126 Patients

Alberto Manassero et al. Local Reg Anesth. .

Abstract

Purpose: Thoracic epidural analgesia (TEA) has been shown to reduce postsurgical morbidity and mortality; nevertheless, major and minor complications can occur. We report our 10-year experience with TEA and incidence of complications.

Patients and methods: Patients received continuous infusion TEA (0.2% ropivacaine and 2 µg ml-1 fentanyl) to control postoperative pain. Every 8 hours, the acute pain service recorded the analgesia regimen and occurrence of side effects. The initial infusion rate was tapered daily in response to improvement in pain symptoms or occurrence of side effects.

Results: A total of 3126 patients received TEA. The median age was 65 years (range, 18-94) and the duration of catheter placement was 3.5 days (range, 2-8). Three major complications were identified (1:1042): two subarachnoid blocks and one epidural abscess which led to permanent sequela (1:3126). Minor complications were hypotension (4.8%), pruritus (4.4%), accidental catheter removal (3.7%), insertion site inflammation (2.5%), motor weakness (2.0%), postoperative nausea and vomiting (1.8%), catheter disconnection (1.9%), catheter occlusion (0.3%), post-dural puncture headache (0.5%), and catheter fragment retention (0.06%), which were the reasons for a 7.4% rate of early discontinuation of epidural analgesia. No occurrence of epidural hematoma, local anesthetic systemic toxicity, and cardiovascular/respiratory depression was recorded.

Conclusion: Postoperative TEA is an advanced technique that poses certain difficulties that can subvert its great potential. While serious complications were rare, minor complications occurred more often and affected the postoperative course negatively. A risk/benefit evaluation of each patient should be done before employing the technique.

Keywords: epidural analgesia; epidural catheter; postoperative pain; spinal epidural abscess; thoracic epidural.

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Conflict of interest statement

The authors report no conflicts of interest in this work.

Figures

Figure 1
Figure 1
Cumulative yearly number of TEA performed.
Figure 2
Figure 2
Distribution of complications expressed as percentage of the total.
Figure 3
Figure 3
MRI documenting the epidural abscess.
Figure 4
Figure 4
Thoracic spine CT showing the retained catheter fragment.
See this image and copyright information in PMC

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