Survey of nerve injury associated with epidural/spinal anesthesia in Japan which occurred in the year 2004

BACKGROUND: The incidence of nerve injury associated with epidural/spinal anesthesia has not been sufficiently investigated in Japan. PURPOSE: The incidence of nerve injury caused by inappropriate epidural/spinal puncture or catheter placement was examined using data obtained by a survey conducted by the Japanese Society of Anesthesiologists for the year 2004. METHODS: In a survey for the year 2004, 1,218,371 anesthetic procedures were registered, among which 548,819 patients were estimated to be anesthetized under epidural/spinal procedures with or without general anesthesia. Twenty nine patients were reported to have incurred nerve injury due to inappropriate epidural/spinal puncture or catheter placement. RESULTS: Seven cases of spinal cord and 22 cases of peripheral nerve injury were reported, with estimated incidences of 1/78,000 and 1/25,000 procedures, respectively. Spinal cord injury developed before the start of surgery in 4 cases, intraoperatively in 1 case, and after the end of surgery in 2 cases. Permanent nerve damage developed in 4 patients with spinal cord injury and 7 patients with peripheral nerve injury. Eighty three percent of these events were reported to be preventable. CONCLUSIONS: The incidence of nerve injury caused by regional anesthesia in Japan seems to be comparable to those reported in the developed countries. To reduce the incidence of this complication, cautious evaluation of the risk/benefit balance in performing regional anesthesia, improving education and supervision of the procedures, and establishing better communication between anesthesiologists and surgeons concerning the timing of catheter removal and the postoperative coagulation state seem to be important.