A Retrospective Analysis Of Neurological Complications Of Neuraxial Anesthesia In64Hospitals In Guangxi

neuraxial anesthesia, including epidural anesthesia （EA）, spinal anesthesia （SA） and combined spinal-epidural anesthesia （CSEA）. It is often used in clinical anesthesia, to keep the patient awake, anesthesia stable, postoperative analgesia easy, and also save medical costs. So neuraxial anesthesia is used for more than100years in clinical medicine.Although neuraxial anesthesia has been proven to be very safe, but it has still complications. Neurological complications might be due to the inferior anesthetic techniques, or by the inherent risks of the anesthesia procedure, such as drugs and operations. Complications include both simple injection pain and permanent nerve damage, and even death. Neurological complications of neuraxial anesthesia are rare, so the exact incidence is difficult to determine. Neuraxial anesthesia is improved in technology and the adoption of new technology in recent years, it is very necessary to reevaluate the incidence of neurological complication. Few neurological complications of neuraxial anesthesia were reported, so the incidence may be underestimated, leading anesthesiologists underestimate the risk of neurological complications. Therefore, it is necessary to establish neurological complications of neuraxial anesthesia database to statistical analysis. Epidemiological data of neurological complications of neuraxial anesthesia is essential, it is an important indicator of the safety and quality of the measurement and assessment of neuraxial anesthesia.Therefore, from January1,2008to December31,2012, a retrospective analysis of neurological complications of neuraxial anesthesia were carried out in64hospitals in Guangxi. To Investigate and analysis the about usage of neuraxial anesthesia at all levels of hospital and calculate the incidence, severity, duration, and related factors of neurological complications, and analysis rehabilitation time, effective time and its sequelae of neurological complications. To accumulate more experience of the clinical use for neuraxial anesthesia and epidemiology data of neurological complications, in order to increase clinical guide of anesthesiologist.PART ONE A PRELIMINARY ANALYSIS ON THE USAGE OF NEURAXIAL ANESTHESIA AND IT’S NEUROLOGICAL COMPLICATIONS IN64HOSPITALS IN GUANGXIObjectiveThe preliminary analysis on the usage of neuraxial anesthesia and the incidence and rehabilitation rates of neurological complications after neuraxial anesthesia in64hospitals in Guangxi. To accumulate the clinical experience of neuraxial anesthesia and epidemiology data of neurological complications after neuraxial anesthesia.MethodsAfter the approval of anesthesia quality control center in Guangxi, a retrospective study analysis was carried out from January1,2008to December 31,2012, to aim at neurological complications of neuraxial anesthesia in64hospitals. Self-designed questionnaire of neurological complications of neuraxial anesthesia. From October2012, informed directors of anesthesiology department at all levels of the hospital’s by both letter and phone message on behalf of anesthesia quality control center in Guangxi Zhuang Autonomous Region to download survey forms on neurological complications of neuraxial anesthesia by internet and finish form1and form2, included age, sex, date of operation, preoperative diagnosis, past medical history, anesthesia techniques, time of anesthesia and operative, surgical technique, anesthesia puncture site and parethesia, usage of postoperative analgesic and anesthetic,record the course of neurological complications, cure and neurological sequelae, and so on To supplement forms by phone or E-mail if it weren’t complete. With SPSS13.0statistical package, Descriptive analysis and x2test and Fisher’s exact test method was used, based on the demographic and clinical characteristics to calculate the incidence and recovery rates of neurological complications. P<0.05considered statistically significant.ResultsFrom2008to2012, there is the most commonly used in CSEA, but also showed an increasing trend. Followed by EA, EA showed a downward trend. SA is used the least. The incidence of neurological complications after neuraxial anesthesia was0.0408%, the incidence of neurological complications of EA, CSEA and SA were0.0201%,0.0552%,0.049%, respectively （P＜0.05）. The incidence of three anesthesia neurological complication were compared, the difference was statistically significant （P=0.000）, the incidence of neurological complication after EA was the least, CSEA was the most. There are statistically significant difference between the incidence of neurological complication of the two kinds grade hospital （P＜0.05）, the incidence of neurological complications in large and comprehensive hospital was more than that of non-large and comprehensive hospital, the odds ratio（OR） was0.589（95%CI:0.442-0.786）. The incidence of TNS was the most,0.0340%, followed by radicular damage （0.005%）, the other three types of complications were relatively rare,0.0008%,0.0008%,0.0002%, respectively （P＜0.05）. The incident of TNS was the least in EA （0.0147%）, the incident of TNS was the most in CSEA （0.047%）（P＜0.05）. The total cure rate of neurological complications was89.8%, the cute rate of three kinds of anesthesia were87.80%,90.26%,90.0%, respectively, the difference was not statistically significant （P＞0.05）. All TNS patients were fully recovered （100%）,48%in radicular damage,25%in cauda equina syndrome, the other two types complication of patients developed permanent damage. The total incidence of permanent neurological complication was0.0042%. The incidence of permanent complications of EA, CSEA and SA were0.0034%,0.0047%and0.0049%（P>0.05）Conclusion1. There is the most commonly used in CSEA, but also showed an increasing trend. Followed by EA, EA showed a downward trend, SA is used the least. The incidence of neurological complications in the large and comprehensive hospital was more than that of the non-large and comprehensive hospital.2. The incidence of neuraxial anesthesia-related complications is very low, the neurological complications of EA was the least. The incidence of permanent complications of EA was the least, that of S A was the most.3. Transient neurological syndrome （TNS） is the most common. The incident of TNS was the least in EA （0.0147%）, the incident of TNS was the most in CSEA （0.047%）（P＜0.05）. Most of the neurological complications could be completely cured.PART TWO A ANALYSIS RELATED FACTORS ON NEUROLOGICAL COMPLICATIONS OF NEURAXIAL ANESTHESIA IN64HOSPITALS IN GUANGXIObjectiveThe investigation and analysis on the severity and duration of neurological complications after neuraxial anesthesia and related factor with neurological complications. To accumulate the clinical experience of neuraxial anesthesia and epidemiology data of neurological complications after neuraxial anesthesia.MethodsAfter the approval of anesthesia quality control center in Guangxi, a retrospective study analysis was carried out from January1,2008to December31,2012, to aim at neurological complications of neuraxial anesthesia in64hospitals. Self-designed questionnaire of neurological complications of neuraxial anesthesia. From October2012, informed directors of anesthesiology department at all levels of the hospital’s by both letter and phone message on behalf of anesthesia quality control center in Guangxi Zhuang Autonomous Region to download survey forms on neurological complications of neuraxial anesthesia by internet and finish form1and form2, included age, sex, date of operation, preoperative diagnosis, past medical history, anesthesia techniques, time of anesthesia and operative, surgical technique, anesthesia puncture site and parethesia, usage of postoperative analgesic and anesthetic, record the course of neurological complications, cure and neurological sequelae, and so on. To supplement forms by phone or E-mail if it weren’t complete. The patients without medication belong to Group I, the patients with medication belong to Group â…¡. Only patients with incapacitating neurologic complications lasting for3month or more were defined severe and long-lasting complications. With SPSS13.0statistical package, x2test and Fisher’s exact test method, Wilcoxon test was used, multivariate analysis using logistic regression, rehabilitation time and effective time were analyzed using the Kaplan-Meier analysis and Cox regression. P＜0.05considered statistically significant.ResultsLogistic regression analysis showed that anesthesia and the type of neurologic complications had great correlation with self-limiting rate. The difference was statistically significant （P＜0.05）. Self-limiting of SA was the highest,90%, that of EA was the lowest, only41.5%（P＜0.05）. Self-limiting of TNS was the highest,83%, self-limiting of TNS was significantly higher than the latter two,（P＜0.05）. The type of neurologic complications and puncture interspace had great correlation with rehabilitation and severe sequelae （P<0.05）. The incidence of rehabilitation of L3-4was the highest,95.3%, that of L1-2was the lowest, only70%; The incidence of severe sequelae of L3₄was the lowest, only1.9%, that of L1-2was the highest,20%. The total incidence of severe sequelae was0.0026%, severe sequelae were the most in Paraplegia, no severe sequelae were developed in TNS. COX regression analysis showed that anesthesia, puncture interspace and the type of neurologic complications had great correlation with rehabilitation time. Rehabilitation mean and median time of EA were longer than those of CSEA and SA, the second were CSEA, the shortest one were SA,（P＜0.05）. Rehabilitation mean and median time of Paraplegia were longer than those of radicular damage and TNS, the second were radicular damage, the shortest one were TNS,（P＜0.05）. Rehabilitation mean and median time of L2.3were longer than those of L3-4and≥L1-2, the second were≥L1-2, the shortest one were L3-4（P＜0.05）. Effective mean and median time of Paraplegia were longer than those of radicular damage and TNS, the second were radicular damage, the shortest one were TNS （P＜0.05）.Conclusion1. Self-limiting of SA was the highest, that of EA was the lowest （P＜0.05）. Self-limiting of TNS was the highest, self-limiting of TNS was significantly higher than the latter two（P＜0.05）.2. Recovery rate of TNS was100%, no severe sequelae were developed in TNS. That of RD was the second. Recovery rate of Paraplegia was the least, only11.1%, severe sequelae were the most in Paraplegia.3. The incidence of rehabilitation of L3-4was95.3%, that of L1-2was70%; The incidence of severe sequelae of L3-4was1.9%, that of L1-2was20%.4. Mean and median of rehabilitation time of EA was longer than those of CSEA and SA, CSEA was the second, the shortest one was SA（P＜0.05）. Mean and median of rehabilitation time and onset time of Paraplegia was longer than those of RD and TNS, RD were the second, the shortest one was TNS（P＜0.05）.