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Infectious complications following regional anesthesia: a narrative review and contemporary estimates of risk
  1. Breethaa Janani Selvamani1,
  2. Hari Kalagara2,
  3. Thomas Volk3,
  4. Samer Narouze4,
  5. Christopher Childs5,
  6. Aamil Patel5,
  7. Melinda S Seering1,
  8. Honorio T Benzon6 and
  9. Rakesh V Sondekoppam7,8
  1. 1University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
  2. 2Department of Anesthesiology and Perioperative Medicine, The University of Alabama at Birmingham, Birmingham, Alabama, USA
  3. 3Department of Anaesthesiology, Intensive Care and Pain Therapy, Saarland University Hospital and Saarland University Faculty of Medicine, Homburg, Germany
  4. 4Western Reserve Hospital Partners, Cuyahoga Falls, Ohio, USA
  5. 5University of Iowa Health Care, Iowa City, Iowa, USA
  6. 6Departments of Anesthesiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
  7. 7Department of Anesthesia, University of Iowa Healthcare, Iowa City, Iowa, USA
  8. 8Department of Anesthesia and Pain Medicine, University of Alberta Faculty of Medicine and Dentistry, Edmonton, Alberta, Canada
  1. Correspondence to Dr Rakesh V Sondekoppam, Department of Anesthesia, University of Iowa Healthcare, Iowa City, IA 52242, USA; rakesh6282{at}gmail.com

Abstract

Introduction Infectious complications following regional anesthesia (RA) while rare, can be devastating. The objective of this review was to estimate the risk of infectious complications following central neuraxial blocks (CNB) such as epidural anesthesia (EA), spinal anesthesia (SA) and combined spinal epidural (CSE), and peripheral nerve blocks (PNB).

Materials and methods A literature search was conducted in PubMed, Embase and Cochrane databases to identify reference studies reporting infectious complications in the context of RA subtypes. Both prospective and retrospective studies providing incidence of infectious complications were included for review to provide pooled estimates (with 95% CI). Additionally, we explored incidences specifically associated with spinal anesthesia, incidences of central nervous system (CNS) infections and, the incidences of overall and CNS infections following CNB in obstetric population.

Results The pooled estimate of overall infectious complications following all CNB was 9/100 000 (95% CI: 5, 13/100 000). CNS infections following all CNB was estimated to be 2/100 000 (95% CI: 1, 3/100 000) and even rarer following SA (1/100 000 (95% CI: 1, 2/100 000)). Obstetric population had a lower rate of overall (1/100 000 (95% CI: 1, 3/100 000)) and CNS infections (4 per million (95% CI: 0.3, 1/100 000)) following all CNB. For PNB catheters, the reported rate of infectious complications was 1.8% (95% CI: 1.2, 2.5/100).

Discussion Our review suggests that the risk of overall infectious complications following neuraxial anesthesia is very rare and the rate of CNS infections is even rarer. The infectious complications following PNB catheters seems significantly higher compared with CNB. Standardizing nomenclature and better reporting methodologies are needed for the better estimation of the infectious complications.

  • complications
  • anesthesia, conduction
  • injections, spinal
  • regional anesthesia
  • outcomes

https://doi.org/10.1136/rapm-2024-105496

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    Footnotes

    • X @rakesh6282

    • Presented at This project was presented at the 48th Annual Spring meeting of the American Society of Regional Anesthesia and Pain Medicine at Hollywood Florida, USA, April 2023.

    • Contributors BJS, HK, MS, AP and RVS helped in the study conception, literature review, data collection, statistical analysis and manuscript preparation. CC helped in literature searches. HTB, SN and TV helped in oversight of the project, supplying additional data through manual searches, manuscript preparation, revision and finalizing.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests RVS receives consultation fees from CIVCO.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.