Epidural hematoma following epidural catheter placement in a patient with chronic renal failure

Abstract

Epidural hematoma following epidural catheter placement in a patient with chronic renal failure Purpose: We report a case of epidural hematoma in a surgical patient with chronic renal failure who received an epidural catheter for postoperative analgesia. Symptoms of epidural hematoma occurred about 60 hr after epidural catheter placement. Clinical features: A 58-yr-old woman with a history of chronic renal failure was admitted for elective abdominal cancer surgery. Preoperative laboratory values revealed anemia, hematocrit 26%, and normal platelet, PT and PTT values. General anesthesia was administered for surgery, along with epidural catheter placement for postoperative analgesia. Following uneventful surgery, the patient completed an uneventful postoperative course for 48 hr. Then, the onset of severe low back pain, accompanied by motor and sensory deficits in the lower extremities, alerted the anesthesia team to the development of an epidural hematoma extending from T~2 to L 2 with spinal cord compression. Emergency decompressive laminectomy resulted in recovery of moderate neurologic function. Conclusions: We report the first case of epidural hematoma formation in a surgical patient with chronic renal failure (CRF) and epidural postoperative analgesia. The only risk factor for the development of epidural hematoma was a history of CRE High-risk patients should be monitored closely for early signs of cord compression such as severe back pain, motor or sensory deficits. An opioid or opioid/local anesthetic epidural solution, rather than local anesthetic infusion alone, may allow continuous monitoring of neurological function and be a prudent choice in high-risk patients. If spinal hematoma is suspected, immediate MRI or CT scan should be done and decompressive laminectomy performed without delay.

Nordic guidelines for neuraxial blocks in disturbed haemostasis from the Scandinavian Society of Anaesthesiology and Intensive Care Medicine

“…Thus, CRF is a definite risk factor for spinal haemorrhage, 3 illustrated by two case reports of post‐CNB SHs, where CRF was the only recognized risk factor 114,115 . There are also two cases of CRF with clopidogrel medication, interrupted 1 week before the CNB, and given LMWH peri‐operatively, 82,83 and one additional case with aspirin medication, intraoperative heparinization, and dextran infusion, apart from his renal disease 116 .…”

Postoperative pain management in patients with chronic kidney disease

“…Although peripheral nerve blocks are used to assist in providing postoperative pain control in ESRD, concern still exists regarding the use of epidural techniques for these patients. [ 15 16 17 ] Hemodialysis has been reported as a risk factor for developing epidural hematoma in hemodialysis patients. [ 15 16 ] However, studies have reported the successful use of epidural analgesia for both obstetrical and nonobstetrical procedures in dialysis patients without developing epidural hematoma.…”

“…[ 15 16 17 ] Hemodialysis has been reported as a risk factor for developing epidural hematoma in hemodialysis patients. [ 15 16 ] However, studies have reported the successful use of epidural analgesia for both obstetrical and nonobstetrical procedures in dialysis patients without developing epidural hematoma. [ 18 19 20 ] Due to the small sample sizes of these reports, it is difficult to provide an estimate of the rate of this complication.…”

Neuraxial pain relief for intractable cancer pain

“…Traditional surgical complications include wound or catheter site infections (10%), bleeding, wound seroma, failure to provide analgesia, spinal headache, spinal catheter leak (2%), rare epidural hematoma formation [40], rare epidural abscess (Fig. 2), rare meningitis, and rare neurologic injury.…”