The National Pediatric Epidural Audit

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.