Infection Risk Is Rare With Epidural and Spinal Blocks, Higher With Peripheral Nerve Block Catheters

Newswise — A review of medical literature conducted by researchers at the University of Iowa Hospital and Clinics found that infections following epidural and spinal blocks are rare. Infections following peripheral nerve block catheters are more common but have been less frequently studied; this may necessitate a review of patient and procedural aspects to lower the risk associated with these procedures.

Nerve blocks are commonly used to numb a part of the body before surgery or after an injury to relieve pain. Such blocks include epidural or spinal blocks, where numbing medication is injected around or into the spine, or peripheral nerve blocks, which numb individual nerves. These procedures are commonly used but, like any procedure, have a risk of resulting in infection. Infections following these blocks can be severe, difficult to treat, and rarely, can lead to death. Therefore, anesthesiologists must understand the risk associated with these procedures and the subsequent outcomes of such infections to practice safely and inform their patients.

In this study, “Infectious Complications Following Regional Anesthesia - Contemporary Estimates of Risk,” researchers sought to determine the reported risk of infections associated with nerve block techniques. They reviewed the medical literature, finding 6783 abstracts published between January 1, 1990, to December 12, 2022, and identified 427 eligible studies for further study of infectious complications. After a final review, 60 studies were used for data collection and analysis.

The team found that the risk of infectious complications following epidural/spinal blocks was rare, with infections occurring in 11 patients per 100,000. The rate of severe central nervous system infections (which included infection of the brain or spinal cord) following epidural and spinal blocks were even rarer at a rate of 3 patients per 100,000 and 2 patients per 100,000, respectively. The rate of infectious complications following peripheral nerve blocks was higher at 1.5% (1.5 patients per 100) but has been studied less extensively. These findings support the current infection control practices for performing spinal and epidural blocks but suggest further study may be needed to gain insight into lowering the infection risk associated with peripheral nerve blocks.

This study has been granted a Best of Meeting Award at the upcoming 48th Annual Regional Anesthesiology and Acute Pain Medicine Meeting. Breethaa Janani Selvamani, MD, will present these findings at a session on Saturday, April 22, at 8:00 am, at The Diplomat Beach Resort in Hollywood, FL. Co-authors are Drs. Hari Kalagara, Aamil Patel, Honorio Benzon, Samer Narouze, Thomas Volk, and Rakesh V. Sondekoppam.

ASRA Pain Medicine is a membership society of more than 5,000 healthcare professionals devoted to advancing evidence-based practice of pain medicine across the pain continuum, from acute pain to chronic pain. Our mission is to advance the science and practice of regional anesthesia and pain medicine to improve patient outcomes through research, education, and advocacy. Our vision is to relieve the global burden of pain. We are committed to integrity, innovation, inclusiveness, service, compassion, and wellness. Learn more at www.asra.com.