• Guideline NAP 3
    Link:www.rcoa.ac.uk/nap3-brief-summary-of-major-results
    • Designed to answer:
      • What types of CNB done in the UK and how often?
      • How often do major complications occur?
      • What happens to these patients experiencing complications?
    • Risks for abscess formation
      • Patient factors
        • Underlying infection
        • Cancer patients
        • Diabetes
        • Patients on immunosupression therapy
        • ITU patients
      • Insertion factors
        • Poor aseptic technique
        • Through traffic
        • Multiple attempts
        • Prolonged catheter duration
        • Redressing
        • Poor follow up procedures
    • Results
      • 700,000 CNBs
      • 46% spinals, 41% epidurals
      • 45% obstetric, 44% perioperatively
      • 84 major complications
        • Pessimistic view
          • 30 permanent injuries
        • Optomistic view
          • 14 permanent injuries
        • Permanent nerve injury
          • 1:25,000 - 50,000
        • Paraplegia or death
          • 1:50,000 - 140,000
        • Epidural morbidity > spinal
        • Poor prognosis
          • Haematoma
          • Spinal cord ischaemia
        • Obstetric complications lower than in general surgical group
        • Higher rate of complications in CSE