Epidural hematoma after epidural block: implications for its use in pain management

Stoll, Amos; Sanchez, Modesto

doi:10.1016/s0090-3019(02)00639-0

Cited by 112 publications

(66 citation statements)

References 43 publications

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“…Previous reports demonstrated spinal epidural hematoma after pain control procedures such as epidural block and acupuncture. Some authors showed spinal epidural hematoma after an epidural block 18,22,24,26,27) . Vandermeulen et al 24) reported 61 patients experiencing spinal epidural hematoma after epidural or subarachnoid block, although 87% of these patients had a coexisting coagulopathy or traumatic needle insertion.…”

Section: Discussionmentioning

confidence: 99%

“…Anatomical factors such as vertebral abnormalities, technical errors like traumatic spinal tap, multiple attempts at needle placement, and pharmacological factors such as use of anti-platelet and anticoagulant therapy may be implicated in the formation and progress of spinal epidural hematoma 3,24) . It may also occur rarely in patients with no history of coagulopathy and anticoagulative medications 22) . We report four cases of spinal epidural hematoma as a complication of pain control procedure.…”

Section: Introductionmentioning

confidence: 99%

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Spinal Epidural Hematoma after Pain Control Procedure

Nam

Choi

Yang

et al. 2010

J Korean Neurosurg Soc

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J Korean Neurosurg Soc 48 : [281][282][283][284] 2010 Spinal epidural hematoma is a rare complication associated with pain control procedures such as facet block, acupuncture, epidural injection, etc. Although it is an uncommon cause of acute myelopathy, and it may require surgical evacuation. We report four patients with epidural hematoma developed after pain control procedures. Two procedures were facet joint blocks and the others were epidural blocks. Pain was the predominant initial symptom in these patients while two patients presented with post-procedural neurological deficits. Surgical evacuation of the hematoma was performed in two patients while in remaining two patients, surgery was initially recommended but not performed since symptoms were progressively improved. Three patients showed near complete recovery except for one patient who recovered with residual deficits. Although, spinal epidural hematoma is a rare condition, it can lead to serious complications like spinal cord compression. Therefore, it is important to be cautious while performing spinal pain control procedure to avoid such complications. Surgical treatment is an effective option to resolve the spinal epidural hematoma.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Spinal Epidural Hematoma after Pain Control Procedure

Nam

Choi

Yang

et al. 2010

J Korean Neurosurg Soc

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“…Epidural hematomas with a diameter of 0.5 cm x 1 cm in the cervical region have been described. 13 At the same time, 10 to 15 mL of blood was found during neurosurgical evacuation of a hematoma in the lumbar region. 14 Many dynamic, but still poorly understood, factors may also play a defining role in development of a hematoma -the presence or absence of compartmentalization of the space, epidural space compliance, CSF pressure, rate of bleeding determining the rate of compression, force of compression, venous pressure in the epidural plexus, and the intraspinal space available for the spinal cord.…”

Section: Etiologymentioning

confidence: 99%

Spinal epidural hematoma occurrence in the absence of known risk factors: A case series

Cullen

Bogdanov

Htut

2004

Journal of Clinical Anesthesia

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“…En varios estudios, se afirma que la incidencia de paraparesia secundaria a anestesia epidural oscila entre 0,0005-0,02% del total 10,28,32 . El periodo para su desarrollo se describe dentro de la primera semana del procedimiento 30 . La mayoría de los hematomas espinales se localizan dorsalmente a la médula espinal sobre todo a nivel cervicotorácico y toracolumbar, teniendo en cuenta que aproximadamente 2/3 de los hematomas se extienden de 2 a 5 niveles.…”

Section: Introductionunclassified

Hematoma epidural cervical yatrogénico: Presentación de un caso clínico y revisión de la literatura

Jusué-Torres¹,

Ortega-Zufiría²,

Tamarit-Degenhardt³

et al. 2011

Neurocirugía

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332 Neurocirugía 2011; 22: 332-336 Resumen Introducción. En la literatura se recogen alrededor de 600 casos de hematomas epidurales espinales. En varios estudios, se afirma que la incidencia de paraparesia secundaria a anestesia epidural oscila entre 0,0005-0,02%. Se han descrito numerosas etiologías, incluyendo cirugía, traumatismos, anticoagulación, malformaciones arteriovenosas, embarazo, procesos hematológicos y punción lumbar. Los procedimientos anestésicos raquídeos y epidurales representan la décima causa más frecuente. Pero en combinación con el tratamiento anticoagulante, dichos procedimientos aumentan su incidencia hasta alcanzar la quinta causa. Publicamos un caso clínico de hematoma epidural cervical yatrogénico en el adulto y el buen resultado obtenido con tratamiento conservador.Caso clínico. Paciente varón de 80 años, que a las 2 horas de tratamiento analgésico de cervicoartrosis mediante infiltración epidural cervical desarrolla intensa cervicalgia y pérdida de fuerza en extremidades inferiores, mostrando paraplejia completa con arreflexia. En RM cervical se evidencia hematoma epidural entre los niveles C4 y T1. Es trasladado a nuestro centro para cirugía pero ante la rápida recuperación se decide tratamiento médico conservador. Al mes de seguimiento, la situación clínica es similar a la previa, sin secuelas con completa reabsorción del hematoma en RM control.Conclusión. Actualmente, la tendencia general es realizar cirugía en pacientes con hematoma espinal y empeoramiento neurológico importante durante las primeras horas. Sin embargo, se pueden obtener buenos resultados neurológicos con tratamiento conservador, en pacientes bien seleccionados con déficit parcial, incompleto y no progresivo. En el presente, no estamos en condiciones de decir qué tratamiento es el mejor para cada caso concreto.

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Epidural hematoma after epidural block: implications for its use in pain management

Cited by 112 publications

References 43 publications

Spinal Epidural Hematoma after Pain Control Procedure

Spinal Epidural Hematoma after Pain Control Procedure

Spinal epidural hematoma occurrence in the absence of known risk factors: A case series

Hematoma epidural cervical yatrogénico: Presentación de un caso clínico y revisión de la literatura

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