Clin J Pain 2019 Apr 18. Epub 2019 Apr 18.
The Department of Pain Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX.
Objectives: The risks of epidural analgesia differ depending on the population studied. We describe our experience with postoperative epidural analgesia for oncologic surgery.
Materials And Methods: After approval from the Institutional Review Board of The University of Texas MD Anderson Cancer Center to conduct this retrospective analysis, we searched our acute pain medicine database for cases in which postoperative epidural analgesia was used between 2003 and 2012. We used word search to identify and catalog cases of neurological changes, magnetic resonance imaging or computed tomography of the spine, electromyography studies, and neurologist or neurosurgeon consultations. Medical records of patients with documented persistent neurological deficits and patients who had spine imaging or neurology consultations were reviewed further. Additionally, we cross-checked medical records with billing diagnosis codes for spinal epidural abscess or hematoma.
Results: We reviewed 18,895 cases in which postoperative epidural analgesia was used. Complications included neurological complaints in 2436 cases (12.9%), epidural insertion site abnormalities in 1062 cases (5.6%), complete epidural catheter migration in 829 cases (4.4%), epidural replacement in 619 cases (3.3%), and inadvertent dura puncture in 322 cases (1.7%). There were 6 cases of persistent deficits of uncertain etiology, 4 deep spinal infections (1:4,724), and 2 cases of catheter tip shearing. No spinal epidural hematomas were identified (95% CI, 0-0.0002).
Discussion: Our findings provide a contemporary review of some risks associated with the use of postoperative epidural analgesia for patients undergoing oncologic surgery. Despite a not-uncommon incidence of neurological changes, serious complications resulting in prolonged sequelae were rare.