Investigation Of Intravertebral Anesthesia With Neurological Complications And Study Of The Effect Of Intensive Education On Neurological Complicationgs In Guangxi

Objective: A retrospective investigation and analysis of intravertebral anesthesia and nerve injury complications were subjected to in hospitals at all levels in Guangxi Zhuang Autonomous Region from 2018 to 2020.Thereafter,further explore the effect of enhanced propaganda and education visits before intravertebral anesthesia was conducted to prevent and treat the nerve complications.Methods: The cases of intravertebral anesthesia and post-anesthesia neurological complications in 207 hospitals of different levels in Guangxi Zhuang Autonomous Region from 2018 to 2020 were collected through the network platform of "Golden Data",and the clinical data of patients with neurological complications and the anesthesia process were analyzed by questionnaire survey,and the top 30 hospitals with high incidence of complications were selected.A further randomized controlled study was conducted on patients undergoing elective surgery underintravertebral anesthesia from December 1,2021 to February 28,2022 in these 30 hospitals.Patients were randomly divided into control group（routine pre-anesthesia missionon visit）and observation group（on the basis of routine pre-anesthesia missionon visit,to introduce the knowledge and precautions of intravertebral anesthesia by using special animated video,special telephone line and issuing leaflets）.Records of the general conditions,two groups of patients with intravertebral anesthesia situation（anesthesia,nerve complications）,neurological complications（time of the first began to neurological complications from anesthesia in patients with symptoms to and signs and time of neurological complications from anesthesia to intravertebral anesthesia in patients with confirmed）and the related scale evaluation in patients with compliance,anxiety score（T₀-1 day of the preoperative,T₁-before anesthesia in the operating room and T₂-on the first day after surgery）,and anesthesia satisfaction.Results: The survey collected 886,425 cases of intravertebral anesthesia and200 cases of neurological complications at 207 hospitals,a rate of 2.26 cases per10,000.There were no significant difference in the incidence of nerve complications among 2018,2019 and 2020 andamong epidural anesthesia,combined spinal and epidural anesthesia and single spinal anesthesia.The incidence of nerve complications after intravertebral anesthesia in tertiary hospitals was higher than that in secondary and lower hospitals（P < 0.05）.There were transient nerve syndrome,spinal nerve root injury and cauda equina syndrome,and the incidence was 75.5%,22.5% and 2%,respectively.Patients with transient nervous syndrome could recover completely after treatment,the recovery rate of patients with spinal nerve root injury was 91.1%,and cauda equina syndrome was 25%.Finally,we selected the top 30 hospitals for the randomized control,and 11,881 patients received intravertebral anesthesia and neurological complications occurred in 14 cases from December 1,2021 to February 28,2022.There was no statistical difference between the two groups in general condition,intravertebral anesthesia method and T₀ anxiety score.Compared with the control group,the observation group had lower T₁ and T₂ anxiety scores,higher anesthesia compliance,lower incidence of intravertebral nerve complications,shorter symptom time and diagnosis time of neurological complications,and higher patient satisfaction（P< 0.05）.Conclusion: Serious neurological complications after intravertebral anesthesia is low,but it may cause permanent neurological damage.Under the premise of standardized anesthesia operation process,clinical anesthesiologists can improve patients’ understand and learning of neurological complications and avoid related factors by strengthening the teaching and visiting mode before anesthesia,so as to prevent the occurrence of intravertebral nerve complications.Complications can be diagnosed at the early stage and treatment measure can be taken early;At the same time,it can also relieve perioperative anxiety and improve patients’ anesthesia compliance and satisfaction.Part 1 Investigation and Analysis of Neurological Complications of Intravertebral Anesthesiain 207 Hospitals in Guangxi Zhuang Autonomous RegionObjective: To retrospectively investigate and analysis the intravertebral anesthesia and neurological complications in hospitals at all levels in Guangxi Zhuang Autonomous Region from 2018 to 2020.Methods: All cases of intravertebral anesthesia and neurological complications in 207 hospitals of different grades in Guangxi Zhuang Autonomous Region from 2018 to 2020 were collected through the network platform of “golden data”,and the clinical data and anesthesia process of the patients with nerve injury complications were further investigated and analyzed by questionnaire.Results: A total of 886425 cases of intravertebral anesthesia were collectedfrom 207 hospital,including 200 cases of neurological complications,with a total incidence of 2.26 per 10,000.From 2018 to 2020,the rates of intravertebral anesthesia nerve complications were to 2.08 cases per 10,000,2.33 cases per 10,000 and 2.36 cases per 10,000,respectively,which is no significant difference.The rate of tertiary hospital of neurological complications after intravertebral anesthesia was higher than that of secondary level hospitals（2.63 cases per 10,000 children versus 1.88 cases per 10,000 children）（P<0.05）.The incidence of epidural anesthesia,combined spinal and epidural anesthesia and single spinal anesthesia reported relatively insignificant rates of 1.86 per 10,000 children,2.42 per 10,000 and 1.32 per 10,000,respectively.Among the 200 patients with complications of nerve injury after intravertebral anesthesia,there were more female patients than male patients,35 patients（17.5%）had a history of spinal anesthesia,149 patients（74.5%）had successful puncture once under intravertebral anesthesia,10 patients（5%）of the tube placement was greater than 3 times,and 54 patients（27%）had abnormal sensation during tube placement.In single spinal anesthesia and combined spinal and epidural anesthesia,36 patients（20.9%）underwent subarachnoid puncture with intervertebral gap L2-3,8 patients（4.7%）with intervertebral gap L1-2,191 patients（95.5%）with epidural needle diameter of 1.6mm.There were 171 cases（99.4%）of patients with spinal anesthesia needle diameter of 0.55 mm,189 cases（98%）of patients with epidural catheter depth < 6cm,and 69% of patients adopted epidural analgesia pump for postoperative analgesia.The main types of nerve complications after intravertebral anesthesia were transient nerve syndrome,cauda equina syndrome and spinal nerve root injury.The incidence of transient nerve syndrome was 75.5%,followed by spinal nerve root injury 22.5% and cauda equina syndrome 2%.There were 25 cases of patients with complications of nerve injury who underwent lumbar CT or MRI examination after surgery,among which 11 cases showed no obvious abnormalities,and 14 cases showed different levels and degrees of lumbar disc herniation,interspinous ligament edema,nerve root compression,and lumbar bone hyperplasia.All patients with transient nervous syndrome were completely recovered after postoperative treatment,the rate of complete recovery was 91.1% in patients with spinal nerve root injury,1 of 4 patients with cauda equina syndrome were completely recovered,and 3 patients had symptoms such as weakness of lower limbs or weak control of urine and feces.Finally,we selected the top 30 hospitals for the second part of the study.Conclusion: Although the incidence of neurological complications after intravertebral anesthesia is relatively low,but serious permanent neurological damage may also exist.Therefore,preoperative evaluation of patients’ general conditions and medical history should be fully conducted,the anesthesia process should be standardized,and the awareness and management of complications after intravertebral anesthesia should be strengthened.Part 2 Effect of Strengthened Preanesthetic Missionon Neurological Complication of Intraspinal AnesthesiaObjective: To investigate the effect of intensive mission and education before intraspinal anesthesia on the prevention of neurological complications in intraspinal anesthesia,and to study whether it is beneficial to the early detection and timely diagnosis of neurological complications in intraspinal anesthesia.Methods: A total of 11881 patients who underwent elective surgery with intraspinal anesthesia from December 1,2021 to February28,2022 were selected from the top 30 hospitals with the highest incidence of neurological complications under intraspinal anesthesia in Guangxi Zhuang Autonomous region from January 2018 to December 2020.The patients were randomly divided into control group（routine preanesthetic missionon interview）and observation group（On the basis of routine preanesthetic missionon,there were introduced,including the knowledge of intraspinal anesthesia,the process of anesthesia,the time of sensorimotor recovery after anesthesia,the symptoms and signs of neurological complications as well as the matters needing attention of intraspinal anesthesia,which showed by means of special animated video of intraspinal anesthesia,official Wechat account of Guangxi anesthesia home or anesthesiology department,special telephone line of anesthesiology department and issuing leaflets of intraspinal anesthesia）.Furthermore,firstly the general condition,including sex,age and ASA grade of the patients in the two groups were recorded.Secondly,the anesthetic compliances were evaluated by self-made scale.Thirdly,the anxiety scores were evaluated by Zung self-rating anxiety scale during pre-anesthesia visit（T₀）,before anesthesia（T₁）and the first day after operation（T₂）.Fourth,the mode of intraspinal anesthesia adopted by the patients was recorded.Fifth,the time from the beginning of anesthesia to the first discovery of symptoms and signs of neurological complications and the time from the beginning of anesthesia to the diagnosis of nerve complications in intraspinal anesthesia were recorded.Finally,the total number of cases of neurological complications in intraspinal anesthesia was counted,as well as the postoperative anesthesia satisfaction of patients was investigated.Results: There was no significant difference in general condition,the mode of intraspinal anesthesia and T₀ anxiety score between the two groups（P> 0.05）.Compared with the control group,the patients in the observation group had lower anxiety scores of T₁ and T₂,higher anesthetic obedience,lower incidence of intraspinal neurological complications,shorter time of finding neurological complications for the first time and diagnosing neurological complications,and higher patient satisfaction（P< 0.05）.Conclusion: It is helpful for the early detection and diagnosis of the nerve complications of intravertebral anesthesia to strengthen the education and visit before anesthesia,so as to win the precious time for early treatment of the neurological complications.It can reduce the incidence of nerve complications in intravertebral anesthesia,relieve perioperative anxiety of patients,improve anesthesia compliance and anesthesia satisfaction of patients,and improve doctor-patient relationship.