Epidural Hematoma After Epidural Blockade in the United States

Horlocker, Terese T.; Kopp, Sandra L.

doi:10.1213/ane.0b013e31828d672e

Cited by 18 publications

(5 citation statements)

References 20 publications

(27 reference statements)

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“…The rate of failure or inadequate analgesia can be as high as 30% with either epidural analgesia, [ 26 , 27 ] or TAP block. [ 20 ] Finally, the rare but catastrophic risk of major complications associated with epidural analgesia such as epidural hematoma [ 28 ] should be included in the considerations.…”

Section: Discussionmentioning

confidence: 99%

The analgesic efficacy of transverse abdominis plane block versus epidural analgesia

et al. 2018

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Background:The aim of the study was to compare the analgesic efficacy of epidural analgesia and transverse abdominis plane (TAP) block. TAP block has gained popularity to provide postoperative analgesia after abdominal surgery but its advantage over epidural analgesia is disputed.Methods:We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement guidelines. Only trials comparing TAP block with epidural analgesia were included. The primary outcome was pain score at rest (analog scale, 0–10) on postoperative day 1 analyzed in subgroups according to the population (children and adults). Secondary outcomes included rate of hypotension, length of stay, and functional outcomes (time to first bowel sound, time to first flatus).Results:Ten controlled trials, including 505 patients (195 children and 310 adults), were identified. Pain scores at rest on postoperative day 1 were equivalent for TAP block and epidural analgesia groups in children (mean difference: 0.3; 95% confidence interval [CI]: −0.1 to 0.6; I2 = 0%; P = .15) and in adults (mean difference: 0.5; 95% CI: −0.1 to 1.0; I2 = 81%; P = .10). The quality of evidence for our primary outcome was moderate according to the GRADE system. The epidural analgesia group experienced a higher rate of hypotension (relative risk: 0.13; 95% CI: 0.04–0.38; I2 = 0%; P = .0002), while hospital length of stay was shorter in the TAP block group (mean difference: −0.6 days; 95% CI: −0.9 to −0.3 days; I2 = 0%; P < .0001), without impact on functional outcomes.Conclusion:There is moderate evidence that TAP block and epidural analgesia are equally effective in treating postoperative pain in both pediatric and adult patients, while TAP block is associated with fewer episodes of hypotension and reduced length of stay.

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Section: Discussionmentioning

confidence: 99%

The analgesic efficacy of transverse abdominis plane block versus epidural analgesia

et al. 2018

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“…Positive experiences are an important beginning of the bonding process between mothers and infants, enhancing the new family's adjustment during the postpartum period [67]. On the other hand, extremely negative birth experiences can be viewed as traumatic and, in some instances, place women at a greater risk of developing clinically significant symptoms of postpartum post-traumatic stress disorder and depression [68].…”

Section: Satisfactionmentioning

confidence: 99%

“…In anesthetic practice there is no evidence that CSE is associated with more infectious complications than spinal or epidural [66], provided a scrupulous aseptic, non-touch technique is used. It is recognized that neurotrauma is more prevalent with intrathecal cannulation and several cases have been reported of damage to the conus medullaris when using a CSE [67]. It is very important therefore that the block be performed at or below the L3/4 interspace, as in a small number of patients the conus medullaris might extend below the L2 vertebral body.…”

Section: Infection and Neurotraumamentioning

confidence: 99%

“…Both these interventions, especially if not correctly performed, may have adverse outcomes, such as severe pain, hemorrhage, or even uterine inversion that represents a life-threatening and unpredictable obstetric emergency which can lead to severe hemorrhage and shock [67,68].…”

Section: Definition and Managementmentioning

confidence: 99%

“…Different international guidelines all recommend an interval of 12 h following prophylactic and 24-36 h following therapeutic doses of LMWH [66][67][68]. Parturients with thrombocytopenia should be evaluated based on the underlying etiology.…”

Section: Epidural Hematomamentioning

confidence: 99%

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