Radiating pain during epidural needle insertion and catheter placement cannot be associated with postoperative persistent paresthesia: a retrospective review

Taichi Kotani,Keiko Uemura,Satoki Inoue,Masahiko Kawaguchi

doi:10.1186/s40981-021-00460-w

Taichi Kotani, Keiko Uemura + Show 2 more

Open Access

https://doi.org/10.1186/s40981-021-00460-w

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Abstract

BackgroundIt has been suggested that radiating pain during spinal or epidural needle insertion and catheter placement can be an indicator of needle-related nerve injury. In this study, using a historical cohort, we investigated what factors could be associated with postoperative persistent paresthesia. In addition, we focused on radiating pain during epidural needle insertion and catheterization.MethodsThis was a retrospective review of an institutional registry containing 21,606 anesthesia cases. We conducted multivariate logistic analysis in 2736 patients, who underwent epidural anesthesia, using the incidence of postoperative persistent paresthesia as a dependent variable and other covariates, including items of the anesthesia registry and the postoperative questionnaire, as independent variables in order to investigate the factors that were significantly associated with the risk of persistent paresthesia.ResultsOne hundred and seventy-six patients (6.44%) were found to have persistent paresthesia. Multivariate analysis revealed that surgical site at the extremities (odds ratio (OR), 12.5; 95% confidence interval (CI), 2.77–56.4; the reference was set at abdominal surgery), duration of general anesthesia (per 10 min) (OR, 1.02; 95% CI, 1.01–1.03), postoperative headache (OR, 1.78; 95% CI, 1.04–2.95), and days taken to visit the consultation clinic (OR, 1.03; 95% CI, 1.01–1.06) were independently associated with persistent paresthesia. Radiating pain was not significantly associated with persistent paresthesia (OR, 1.56; 95% CI, 0.69–3.54).ConclusionRadiating pain during epidural procedure was not statistically significantly associated with persistent paresthesia, which may imply that this radiating pain worked as a warning of nerve injury.

Highlights

Accidental puncture of the spinal cord or nerve roots elicits severe radiating pain in conscious patients
We may need to reconsider our practical attitude for epidural anesthesia if radiating pain per se during epidural needle insertion and catheterization could be strongly associated with persistent neurologic complications
Univariate analysis revealed that older age, presence of coexisting disease, surgical sites, subcutaneous injection pain, radiating pain, requirement of transfusion, intraoperative adverse intraoperative events, duration of anesthesia and surgery, intensity of postoperative pain, postoperative headache, and longer time taken to visit the postoperative anesthesia consultation clinic were candidates associated with persistent paresthesia for the multivariate analysis

Summary

Introduction

Accidental puncture of the spinal cord or nerve roots elicits severe radiating pain in conscious patients. Needle-related neurologic complications are likely to be avoided if the inserted needle is retracted promptly when the radiating pain is elicited [1]. According to this opinion, we usually provided epidural anesthesia in awake or lightly sedated status before providing general anesthesia. It has been suggested that radiating pain during spinal or epidural needle insertion and catheter placement can be an indicator of needle-related nerve injury. We focused on radiating pain during epidural needle insertion and catheterization

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Conclusion