The risk from painkilling epidurals is lower than many patients may imagine, finds a new analysis.
Researchers led by Dr Tim Cook of the Royal United Hospital in Bath, UK, decided that limited information on the risk of serious complications was "impeding clinical decision-making and patient consent" over epidurals and spinal anaesthetics.
The team carried out a national census of 707,455 central neuraxial block (CNB) procedures, including epidurals, performed in the NHS in 2006. The procedures were given to relieve labour pain, chronic pain, or pain during an operation.
All major complications were assessed. These included abscess in the vertebral canal, internal bleeding, meningitis, nerve injury, loss of blood supply to the spinal cord, and death from cardiovascular collapse.
A total of 84 major complications were reported, of which up to 30 were classed as permanent injuries. This equates to a risk of 4.2 per 100,000 procedures. An "optimistic" analysis of the figures produced a risk of 2.0 per 100,000 procedures. There were between five and 13 deaths or paraplegias, depending on the form of analysis.
In the British Journal of Anaesthesia, the authors say the results are reassuring for patients. They write: "The data are reassuring and suggest that central neuraxial block has a low incidence of major complications, many of which resolve within six months."
Dr Cook said: "The results are reassuring for patients with all procedures and settings being lower risk than many previous estimates. It is likely that this study will become widely quoted as the definitive estimate of these rare but potentially catastrophic complications.
He added: "Although complications related to epidurals are rare, the profession still needs to examine how and why these complications arise and make steps to reduce their frequency.
"For instance, it is likely that the number of complications could be further reduced by a greater appreciation that prolonged weakness of the legs after an epidural or spinal is not normal and should be investigated by an experienced doctor to ensure a major complication is not developing."
Mr Charlie McLaughlan of the Royal College of Anaesthetists added: "This is good news. We have not had reliable data on the risks before. I think patients have probably been under the impression that the risk was greater than it actually was and this could have put them off the procedures."
Cook, T. M. et al. on behalf of The Royal College of Anaesthetists Third National Audit Project. Major complications of central neuraxial block: report on the Third National Audit Project of the Royal College of Anaesthetists. British Journal of Anaesthesia, published online January 12, 2009.
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