Epidural hematoma after thoracic epidural analgesia in a patient treated with ketorolac, mefenamic acid, and naftazone: a case report

Abstract

A 26-year-old male undergoing thoracotomy and bleeding control received a preoperative thoracic epidural for postoperative analgesia. On the fifth postoperative day, paralysis of both lower limbs occurred and urgent magnetic resonance imaging showed massive anterior epidural hematoma. During laminectomy and decompression, platelet dysfunction was diagnosed and preoperative non-steroidal anti-inflammatory drugs medications were supposed to the cause of platelet dysfunction. After infusion of ten units of platelet concentrate, coagulopathy was improved. We should be more careful to drugs with antiplatelet effect when using regional analgesia.

The effects of ultrasound-guided serratus plane block, in combination with general anesthesia, on intraoperative opioid consumption, emergence time, and hemodynamic stability during video-assisted thoracoscopic lobectomy

“…[23] However, it involves unnecessary bilateral block, including the sympathetic nervous system, and several complications, such as hypotension, epidural hematoma, abscess, and dural puncture. [28,29] Hence, some clinicians have suggested paravertebral block as the new gold standard because it has similar efficacy with regard to pain control; less hypotension; and lower risk of epidural hematoma and abscess, and dural puncture compared with epidural block. [1,30,31] However, it has also some drawbacks, such as pneumothorax and difficult technique despite the use of ultrasound.…”