Epidural hematoma after epidural anesthesia: a case report of non-surgical management

Otsu, Ichiro; Merrill, Douglas G.

doi:10.1016/s1366-0071(03)00006-8

Cited by 6 publications

(2 citation statements)

References 7 publications

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“…It was only after the return of neurological symptoms 4 days later that she required surgical decompression. Other cases of successful conservative management of epidural hematomas have been reported [6][7][8][9][10][11][12]. Although expectant management may be reasonable in some cases, frequent neurological assessment is mandatory, as our case has demonstrated.…”

Section: Discussionmentioning

confidence: 48%

Atypical presentation of an epidural hematoma in a patient receiving aspirin and low molecular weight heparin. Was epidural analgesia the right choice?

Kasodekar¹,

Goldszmidt²,

Davies³

2009

Journal of Clinical Anesthesia

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Section: Discussionmentioning

confidence: 48%

Atypical presentation of an epidural hematoma in a patient receiving aspirin and low molecular weight heparin. Was epidural analgesia the right choice?

Kasodekar¹,

Goldszmidt²,

Davies³

2009

Journal of Clinical Anesthesia

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“…1,2 In fact, MRI is the criterion standard for diagnosing epidural hematoma, which may occur following placement of an epidural catheter. [3][4][5][6][7] However, whether to remove epidural and peripheral nerve catheters during MRI or to leave them in place is uncertain because of potential concerns over device heating, movement, or interference with MRI during scanning.…”

mentioning

confidence: 99%

Evaluation of Epidural and Peripheral Nerve Catheter Heating During Magnetic Resonance Imaging

Owens¹,

Erturk

Ouanes³

et al. 2014

Regional Anesthesia and Pain Medicine

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Background Many epidural and peripheral nerve catheters contain conducting wire that could heat during magnetic resonance imaging (MRI), requiring removal for scanning. Methods We tested 2 each of 6 brands of regional analgesia catheters (from Arrow International, B. Braun Medical, and Smiths Medical/Portex) for exposure to clinical 1.5 and 3 Tesla (T) MRI. Catheters testing as non-magnetic were placed in an epidural configuration in a standard human torso-sized phantom, and an MRI pulse sequence applied at the maximum scanner-allowed radio frequency (RF) specific absorption rate (SAR) for 15 minutes Temperature and SAR exposure were sampled during MRI using multiple fiber-optic temperature sensors. Results Two catheters (the Arrow StimuCath Peripheral Nerve, and Braun Medical Perifix FX Epidural) were found to be magnetic and not tested further. At 3T, exposure of the remaining 3 epidural and 1 peripheral nerve catheter to the scanner’s maximum RF exposure, elicited anomalous heating of 4 to 7°C in 2 Arrow Epidural (MultiPort and Flex-Tip Plus) catheters at the entry points. Temperature increases for the other catheters at 3T and all catheters at 1.5T were ≤1.4°C. When normalized to the body-average FDA guideline SAR of 4W/kg, maximum projected temperature increases were 0.1 to 2.5°C at 1.5T and 0.7 to 2.7°C at 3T, except for the Arrow MultiPort Flex-Tip Plus catheter at 3T whose increase was 14°C. Conclusions Most but not all catheters can be left in place during 1.5T MRI scans. Heating of <3°C during MRI for most catheters is not expected to be injurious. While heating was lower at 1.5T vs 3T, performance differences between products underscore the need for safety testing before performing MRI.

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Neuraxial blocks and spinal haematoma: Review of 166 case reports published 1994–2015. Part 1: Demographics and risk-factors

Lagerkranser

2017

Scandinavian Journal of Pain

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AbstractBackgroundBleeding into the vertebral canal causing a spinal haematoma (SH) is a rare but serious complication to central neuraxial blocks (CNB). Of all serious complications to CNBs such as meningitis, abscess, cardiovascular collapse, and nerve injury, neurological injury associated with SH has the worst prognosis for permanent harm. Around the turn of the millennium, the first guidelines were published that aimed to reduce the risk of this complication. These guidelines are based on known risk factors for SH, rather than evidence from randomised, controlled trials (RCTs). RCTs, and therefore meta-analysis of RCTs, are not appropriate for identifying rare events. Analysing published case reports of rare complications may at least reveal risk factors and can thereby improve management of CNBs. The aims of the present review were to analyse case reports of SH after CNBs published between 1994 and 2015, and compare these with previous reviews of case reports.MethodsMEDLINE and EMBASE were used for identifying case reports published in English, German, or Scandinavian languages, using appropriate search terms. Reference lists were also scrutinised for case reports. Twenty different variables from each case were specifically searched for and filled out on an Excel spreadsheet, and incidences were calculated using the number of informative reports as denominator for each variable.ResultsAltogether 166 case reports on spinal haematoma after CNB published during the years between 1994 and 2015 were collected. The annual number of case reports published during this period almost trebled compared with the two preceding decades. This trend continued even after the first guidelines on safe practice of CNBs appeared around year 2000, although more cases complied with such guidelines during the second half of the observation period (2005–2015) than during the first half. Three types of risk factors dominated:(1)Patient-related risk factors such as haemostatic and spinal disorders, (2) CNB-procedure-related risks such as complicated block, (3) Drug-related risks, i.e. medication with antihaemostatic drugs. Conclusions and implicationsThe annual number of published cases of spinal haematoma after central neuraxial blocks increased during the last two decades (1994–2015) compared to previous decades. Case reports on elderly women account for this increase.Antihaemostatic drugs, heparins in particular, are still major risk factors for developing post-CNB spinal bleedings. Other risk factors are haemostatic and spinal disorders and complicated blocks, especially “bloody taps”, whereas multiple attempts do not seem to increase the risk of bleeding. In a large number of cases, no risk factor was reported. Guidelines issued around the turn of the century do not seem to have affected the number of published reports. In most cases, guidelines were followed, especially during the second half of the study period. Thus, although guidelines reduce the risk of a post-CNB spinal haematoma, and should be strictly adhered to in every single case, they are no guarantee against such bleedings to occur.

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Epidural hematoma after epidural anesthesia: a case report of non-surgical management

Cited by 6 publications

References 7 publications

Atypical presentation of an epidural hematoma in a patient receiving aspirin and low molecular weight heparin. Was epidural analgesia the right choice?

Atypical presentation of an epidural hematoma in a patient receiving aspirin and low molecular weight heparin. Was epidural analgesia the right choice?

Evaluation of Epidural and Peripheral Nerve Catheter Heating During Magnetic Resonance Imaging

Neuraxial blocks and spinal haematoma: Review of 166 case reports published 1994–2015. Part 1: Demographics and risk-factors

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