Epidural haematoma: Rare complication after spinal while intending epidural anaesthesia with long-term follow-up after conservative treatment

Abstract

Epidural anaesthesia (EA) is an extensively used procedure for many surgeries. Increase incidence of bleeding in the epidural space [epidural haematoma (EH)] is reportedly more common in patients with altered coagulation and patients on anticoagulation treatment. EH secondary to spinal while intending EA for caesarean section (C-section) in a healthy individual leading to transient or persistent neurological problems is very rare. We report a case of EH after spinal while intending EA for C-section in a healthy young female along with 5-yrs follow-up after conservative treatment.

Prolonged post spinal anaesthesia paralysis

“…The incidence of haematoma is approximated to be <1 in 150,000 epidurals, and it is even rarer following spinal anaesthesia (1 in 220,000) in patients with no added morbidity. [ 8 ] Symptoms occur acutely as in our patient and depend on the extent of bleed and its progression. This rare entity is more common in patients with coagulation abnormalities (drug induced or otherwise), pregnant patients with engorged vessels, arteriovenous (AV) abnormalities and in those cases where multiple attempts for regional anaesthesia are undertaken.…”

“…Though the closed space in spinal canal prevents significant bleeds due to tamponade effect, it generates pressure high enough to cause dangerous neurological compromise, presenting as prolongation of return of blockade, backache, numbness, weakness progressing to paraplegia, loss of bowel and bladder function, headache and neck stiffness (especially in subarachnoid haematoma) and decreased deep tendon reflexes. [ 8 ] Nerve injury may be minimised by surgical decompression within 24 h of the first symptoms. [ 8 ] Prognosis depends on the rate of development of symptoms, interval to surgery, level of spinal involvement and degree of neurological deficit.…”

Cauda equina syndrome after repeated spinal attempts: A case report and review of the literature

“…In another case,[ 14 ] SA was given while intending epidural anesthesia for LSCS and needle induced injury of dilated epidural veins caused epidural hematoma. Patient was successfully managed conservatively as she didn’t consent for decompression surgery.…”

“…[ 16 ] Spontaneous resolution of ASSH has been also reported in very rare cases. [ 17 ] and there are case reports[ 14 ] where conservative management has been done successfully.…”

Enhanced Recovery After Surgery (ERAS) in the Field of Orthopedics and Traumatology

“…Epidural analjezi, bir zamanlar alt ekstremite total eklem artroplastisini takiben postoperatif ağrı kontrolü için altın standart iken, emboli kemoprofilaksisi sonrası spinal hematom riski nedeniyle önemini kaybetmiştir (20) .…”