A 6-month Audit of the Complications of Central Neuraxial Block (CNB) at Vaiola Hospital, Tonga.

BACKGROUND
Central Neuraxial Block (CNB) involves injecting local an aesthetics to the nerves around the Central Nervous System. These include subarachnoid blocks (SAB) or spinal block, epidurals, caudal and combined spinal and epidurals.
Vaiola Hospital is the main tertiary referral hospital in the Kingdom of Tonga. CNBs are commonly used because it is cost effective and considered safer than General an aesthetics (GA). This is the first prospective study of the complications of CNB carried out at Vaiola Hospital from Dec 2012 to May 2013.
METHODS
A data collection tool (Annex 2) was used by the anesthetist and nurse performing the CNBs during the period of study. An inclusion and exclusion criteria was used to recruit patients who had a CNB during the period of this study. Patients and staff were informed of the possible complications and requested to report and document them. Patients were followed up for the duration of their symptoms and while in hospital. Any complication was promptly treated soon as detected and followed up even if they are discharged for possi ble sequelae.
RESULTS
A total of 240 cases of CNBs were performed over the period of study; 25 were excluded as 17 were ASA III and 8 cases had missing or inadequate records. Therefore the sample size for this study was 215. There were .l~9 cases who had complications.
The most frequent complications were ?hivering (59 cases) 35'% followed by 45 cases of hypotension (27%). They were adequately managed with no untoward events. There were i 4 bradycardia, 16 cases had nausea and shivering. There was I case of Post Dural Puncture Headache (PDPH), 1 transient paresthesia, and 3 had headaches. There were 3 high spinals.
6 cases o(failed block who required general anesthesia; and 6 had inadequate block who
required some sedation and analgesia. There were no major complications such as total spinal, systemic toxicity, cardiac arrest or death and no long-term sequelae at the end of study period.
CONCLUSION
Majority (99%) of central neuraxial blocks (CNB) in the study period were sub~achnoid
blocks. Most of complications were minor who were treated adequately wifuno untoward
events. There was a high incidence 78% of CNB complications.
Incidence of post-Dural puncture headache was 0.6%, comparable to the world -wide
incidence. A larger sample and longer period of this kind of study is needed, so this is the
start!! to give a more powerful conclusion and recommendations for future standard
protocol. However, there were no major complications at the end of this study.
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