Detection and management of epidural haematomas related to anaesthesia in the UK: a national survey of current practice

Meikle, J.; Bird, Steven T.; Nightingale, J. J.; White, Nigel

doi:10.1093/bja/aen170

Cited by 42 publications

(27 citation statements)

References 11 publications

(5 reference statements)

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“…Similarly to other organisations [2], codeine has now been removed from the list of medications that can be dispensed for home use, and is not routinely available on the ward, patients being given regular paracetamol for seven days and ibuprofen for three days to take home, instead. A follow-up audit is intended to assess analgesia in the light of these changes.…”

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confidence: 99%

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Magnetic resonance imaging safety of Epilong Soft epidural catheters

2014

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confidence: 99%

“…Under these circumstances, computed tomography may be a safer alternative if MRI compatibility of the indwelling epidural catheter is uncertain [2]. …”

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confidence: 99%

Magnetic resonance imaging safety of Epilong Soft epidural catheters

2014

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“…Risk factors for epidural hematoma after epidural catheter placement include antithrombotic and antiplatelet therapy, traumatic placement, and a history of coagulation abnormality. The hematoma can develop at any time after the procedure, whether a catheter is placed or not, and can happen following catheter removal [2,3]. One study reports that 50% of hematomas occur after catheter removal [4].…”

Section: Discussionmentioning

confidence: 99%

“…It is a true neurological emergency, and evacuation of the hematoma needs to be done as soon as possible after establishment of a diagnosis. Magnetic resonance imaging is the standard means of diagnosis [3] but can also be diagnosed by CT scan. The sooner the decompression is done the better [3], obviously, but if it is done within 8 hours the outlook for return of function is good.…”

Section: Discussionmentioning

confidence: 99%

“…Magnetic resonance imaging is the standard means of diagnosis [3] but can also be diagnosed by CT scan. The sooner the decompression is done the better [3], obviously, but if it is done within 8 hours the outlook for return of function is good. In our patient, the complaint of severe back pain 3 hours or so after epidural placement was certainly consistent with the possibility of epidural hematoma formation, despite the fact that his coagulation studies were normal, the lack of antithrombotic therapy, and atraumatic catheter placement.…”

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confidence: 99%

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Back Pain Following Thoracic Epidural Placement-Now What?

Rose

McLarney²

2012

J Anesthesiol Clin Sci

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We describe a case of severe back pain following thoracic epidural placement. We discuss the differential for such a case, and the management as well.One of the most feared complications of epidural placement is epidural hematoma. Back pain following epidural catheter placement can have several causes, from those of a trivial nature to those that are a true medical emergency, and can range in degree from mildly sore to excruciating in nature. We present a case of severe back pain shortly following epidural catheter placement that mimicked epidural hematoma but was not. CaseA 66 year old 80 kilogram white male with non-small cell carcinoma of the lung was scheduled for a thoracotomy with excision of the mass. His past medical history was significant for a 100 pack-year cigarette smoking history, hypertension, and osteoarthritis. He took no antithrombotic or antiplatelet drugs, and had no history of bleeding diatheses or easy bruising. His coagulation studies were within normal limits, specifically a platelet count of 428, PT/INR 10.8/1.0, and PTT of 29. After sedation with 2 milligrams of midazolam administered intravenously, an epidural catheter was placed at the level of T6/T7 via a midline insertion for postoperative pain control preoperatively in the holding room. The placement itself was unremarkable, with loss of resistance (with air) at 7 centimeters, and the catheter was easily threaded to 12 centimeters at the skin. A 3 milliliter test dose of 1.5% lidocaine with epinephrine 1:200,000 was negative. The patient tolerated the procedure well.The patient's entrance into the operating room was delayed for a time. Three and a half hours later, the holding room staff advised us that the patient was complaining of severe back pain. The patient was found to be sitting on the side of the bed, asking for the epidural catheter to be removed. He said lying on the bed was too painful. He related that his pain was 10/10, sharp in nature, in the immediate area of the epidural catheter. He also related that dorsiflexion of his feet worsened the pain. There was slight radiation of the pain superiorly. His strength in all extremities was normal, and his patellar reflexes were intact. The epidural site was normal in appearance, and no blood or clear fluid was obtained upon aspiration of the catheter.A stat magnetic resonance imaging (MRI) was ordered, and neurosurgery was alerted to be on standby in case an epidural hematoma was discovered on imaging. The MRI showed no evidence of epidural hematoma, and the epidural catheter was visible in the epidural space; there was an incidental finding of a hemangioma in the body of the T4 vertebra. Furthermore, there was no significant disc disease or osteoarthritic changes.The catheter was removed following the MRI; over the next few hours, his pain gradually decreased. The patient was treated with opiate analgesics overnight, and the surgery was postponed. The patient underwent his planned thoracotomy the next day, and his postoperative pain was managed by intravenous, and t...

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