Spinal epidural hematoma is a rare but a serious condition, with high morbidity and mortality, leading to significant neurological deficiencies. One of the main causes of spinal epidural hematoma is spinal puncture during anaesthetic procedures. We report
Abstract
Spinal epidural hematoma is a rare but a serious condition, with high morbidity and mortality, leading to significant neurological deficiencies. One of the main causes of spinal epidural hematoma is spinal puncture during anaesthetic procedures. We report an interesting case of an epidural hematoma following the use of an epidural catheter of continuous postoperative epidural analgesia (CPEA), following a Whipple procedure. This case is particularly interesting, due to the delayed onset of the hematoma, the total absence of predisposal factors and the uneventful patient’s recovery following immediate surgical intervention.
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References
Al-Mutair A, Bednar DA. Spinal epidural hematoma. J Am Acad Orthop Surg. 2010 Aug;18(8): 494–502.
Boco T, Deutsch H. Delayed symptomatic presentation of epidural hematoma after epidural catheter anesthesia: case report: Case report. Spine (Phila Pa 1976). 2007;32(22):E649-51.
Bos EME, Haumann J, de Quelerij M, et al. Haematoma and abscess after neuraxial anaesthesia: a review of 647 cases. Br J Anaesth. 2018;120(4):693-704.
Bonica JJ. Management of pain with regional analgesia. Postgraduate medical journal. 1984;60(710):897.
Brull R, McCartney CJL, Chan VWS, El-Beheiry H. Neurological complications after regional anesthesia: contemporary estimates of risk. Anesth Analg. 2007 Apr;104(4):965–74.
Domenicucci M, Mancarella C, Santoro G, Dugoni DE, Ramieri A, Arezzo MF, et al. Spinal epidural hematomas: personal experience and literature review of more than 1000 cases. J Neurosurg Spine. 2017 Aug;27(2):198–208.
Domenicucci M, Ramieri A, Paolini S, Russo N, Occhiogrosso G, Di Biasi C, et al. Spinal subarachnoid hematomas: our experience and literature review. Acta Neurochir (Wien). 2005 Jul;147(7):741–50; discussion 750.
Drake R, Vogl AW, Mitchell AW, Tibbitts R, Richardson P. Gray’s Atlas of Anatomy E-Book. Elsevier Health Sciences; 2020.
Han IS, Chung EY, Hahn Y-J. Spinal epidural hematoma after epidural anesthesia in a patient receiving enoxaparin -A case report-. Korean J Anesthesiol. 2010 Aug;59(2):119–22.
Hogan QH. Epidural anatomy examined by cryomicrotome section: influence of age, vertebral level, and disease. Regional Anesthesia: The Journal of Neural Blockade in Obstetrics, Surgery, & Pain Control. 1996;21(5):395–406.
Hogan Q. Spinal Anatomy. In Hahn M., In Hahn Μ., McQuίllan Ρ., & Sheplock g., ed. Regional Anesthesia. Αn Atlas of Anatomy and Techniques. Mosby 1st ed, 1996:205-212.
Horlocker TT, Wedel DJ. Anticoagulation and neuraxial block: historical perspective, anesthetic implications, and risk management. Reg Anesth Pain Med. 1998 Dec;23(6 Suppl 2):129–34.
Horlocker TT, Wedel DJ, Benzon H, Brown DL, Enneking FK, Heit JA, et al. Regional anesthesia in the anticoagulated patient: defining the risks (the second ASRA Consensus Conference on Neuraxial Anesthesia and Anticoagulation). Reg Anesth Pain Med. 2003 Jun;28(3):172–97.
Ikuta K, Tono O, Tanaka T, Arima J, Nakano S, Sasaki K, et al. Evaluation of postoperative spinal epidural hematoma after microendoscopic posterior decompression for lumbar spinal stenosis: a clinical and magnetic resonance imaging study. J Neurosurg Spine. 2006 Nov;5(5):404–9.
Inoue K, Yokoyama M, Nakatsuka H, Goto K. Spontaneous resolution of epidural hematoma after continuous epidural analgesia in a patient without bleeding tendency. Anesthesiology. 2002 Sep;97(3):735–7.
Jackson R. Case of spinal apoplexy. Lancet. 2:5-6;1869.
Kahle W, Frotcher M. Color Atlas of Human Anatomy, Vol. 3: Nervous System and Sensory Organs. 7th Edition. Thieme; 2015.
Lawton MT, Porter RW, Heiserman JE, Jacobowitz R, Sonntag VK, Dickman CA. Surgical management of spinal epidural hematoma: relationship between surgical timing and neurological outcome. J Neurosurg. 1995 Jul;83(1):1–7.
Lee LA, Posner KL, Domino KB, Caplan RA, Cheney FW. Injuries associated with regional anesthesia in the 1980s and 1990s: a closed claims analysis. Anesthesiology. 2004 Jul;101(1):143–52.
Liu H, Brown M, Sun L, Patel SP, Li J, Cornett EM, et al. Complications and liability related to regional and neuraxial anesthesia. Best Pract Res Clin Anaesthesiol. 2019 Dec;33(4):487–97.
Mauermann WJ, Shilling AM, Zuo Z. A comparison of neuraxial block versus general anesthesia for elective total hip replacement: a meta-analysis. Anesth Analg. 2006 Oct;103(4):1018–25.
Mukerji N, Todd N. Spinal epidural haematoma; factors influencing outcome. Br J Neurosurg. 2013;27(6):712-717.
Rosero EB, Joshi GP. Nationwide incidence of serious complications of epidural analgesia in the United States. Acta Anaesthesiol Scand. 2016 Jul;60(6):810–20.
Ruppen W, Derry S, McQuay H, Moore RA. Incidence of epidural hematoma, infection, and neurologic injury in obstetric patients with epidural analgesia/anesthesia. Anesthesiology. 2006 Aug;105(2):394–9.
Sokolowski MJ, Garvey TA, Perl J, Sokolowski MS, Akesen B, Mehbod AA, et al. Postoperative lumbar epidural hematoma: does size really matter? Spine. 2008 Jan 1;33(1):114–9.
Usubiaga JE. Neurological complications following epidural anesthesia. Int Anesthesiol Clin. 1975;13(2):1–153.
Umegaki, T., Hirota, K., Ohira, S., Uba, T., Kusunoki, M., Okamoto, A., Nishi, K. and Kamibayashi, T. (2016). Rapid development of a spinal epidural hematoma following thoracic epidural catheter removal in an esophageal carcinoma surgical patient: a case report. JA clinical reports, 2(1) p. 37.
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