- General Considerations
- Please use existing complication categories and avoid using “other” (e.g. a catheter disconnect should be a “catheter problem”, not “other… catheter disconnect”) and reclassify complications during the audit process if necessary.
- Please do not hesitate to use free text and comments. These are very valuable for data analysis. Any complications or subtypes listed as “other” require comment.
- Please ensure that follow-up questions are completed for all complications: severity grading/outcome, interventions needed (e.g., remove catheter, administer antibiotics, consults), location, number of days to complication, length of hospitalization increase.
- Definitions
- Intraoperative
- positive test dose – > 10% increase in HR or SBP or 25% increase in T-wave amplitude, patient-reported symptoms (tinnitus, circumoral numbness, metallic taste)
- inadvertent dural puncture – CSF aspirate (or free-flow via needle or catheter)
- inadvertent vascular puncture -blood aspirated in syringe (or free-flow via needle or catheter)
- abandoned block – unable to place block or thread catheter; block aborted for any reason
- failed block – technically successful (completed) block but not clinically successful based on clinical assessment, e.g., alteration in anticipated anesthetic needs
- respiratory – hemo/pneumothorax, diaphragmatic paralysis causing respiratory insufficiency, apnea, other
- cardiovascular – arrhythmia, cardiac arrest, other
- neurologic – altered mental status, seizure, other
- other – only a complication that cannot be placed into any of the above categories; details should be specified in database free text box
- Postoperative
- failed block – technically successful block but not successful based on clinical assessment, e.g., lack of analgesia or evidence of blockade in recovery area
- unintentional unilateral block – applies to neuraxial techniques; regardless of whether the side blocked is operative or nonoperative
- prolonged block – greater than anticipated duration for single-injection or after catheter is removed
- excessive motor blockade – physician judgment based on local anesthetic dosing and clinical situation (e.g., cannot complete physical therapy, delayed ambulation)
- catheter problem – any catheter issue that precludes delivery of planned regional infusion (e.g., occluded, kinked, accidental dislodgement, disconnected at hub/infusion pump, fractured or retained catheter), other
- adverse drug reaction – local anesthetic toxicity, anaphylaxis
- respiratory – respiratory depression, apnea, diaphragmatic paralysis causing respiratory insufficiency, other
- neurologic – seizure, paresthesia/dysesthesia, paralysis, post-dural puncture headache, altered mental status, Horner syndrome, other
- hematoma – epidural or peripheral
- infection – insertion site (erythema, cellulitis), deep (abscess, meningitis)
- other – only a complication that cannot be placed into any of the above categories; details should be specified in database free text box