Haematoma following epidural anaesthesia

Abstract

HAEMOIRRHAGE INTO the spinal epidural space associated with epidural catheterization and anticoagulation represents a rare and serious complication of spinal epidural anaesthesia with three cases 1,2,a described in the literature to the present time. Because of the increased use of this form of analgesia, the complication is probably even rarer than the cases reported would indicate. An awareness of this complication is no less compelling because of its potentially serious outcome, and possible remedy by prompt surgery. CASE I~EPOIRTA 70-year-old man was admitted to the hospital with a thirty-six hour history of numbness of the left foot, which later became cold, cyanotic and mildly painful. There was a history of "cold hands and feet" since 1962. At that time skin and muscle biopsies were performed and a diagnosis of scleroderma was made. Examination revealed thick skin and deformed nails of the fingers and toes. The left foot was cold, cyanotic to the level of the lateral maleolus, and pulses were absent. Pulse was present in the posterior tibial artery on the right. Pulses in the femoral and popliteal arteries were present and normal bilaterally.Before left anterior and posterior tibial embolectomy, epidural analgesia was induced using an epidural catheter inserted at the L-2--3 space and 2 per cent lidocaine. At the point of inserting the catheter no abnormal bleeding was noted. During the operation 10,000 units of heparin were given intravenously. The interval between catheterization and heparinization was about sixty minutes. Sympathetic blockade was maintained postoperatively by intermittent use of epidural lidocaine 1 per cent. Heparinization was continued as well. Clotting times were 9,0.5 minutes and 32 minutes at three and seven hours postoperatively. Thirteen hours after operation the epidural catheter was removed, as no further benefit was being obtained from sympathetic blockade. Clotting time was 24.5 minutes at that time. At about 24 hours after operation the patient began to complain of severe back pain. Examination by a house officer revealed no neurological deficit. Locally applied heat produced relief. At 25 hours postoperatively, the patient complained of numbness in both hands and the right leg, unassociated with back or extremity pain. Two hours later there was progression of the numbness and a "feeling of choking to death." Shortly after this, examination revealed a sensory level at T-2, paraplegia and severe weakness of the arm extensors, wrist extensors and flexors, and intrinsic hand muscles. Lumbar myelography demon-*Dep.t

Extradural Haematoma After Continuous Extradural Anaesthesia

“…Although blood dyscrasias and anticoagulation therapy are recorded as contraindications to extradural or subarachnoid anaesthesia in most textbooks, there have been a few reports of extradural haematoma in patients given anticoagulants after catheter placement [6][7][8][9][10], mostly with poor outcome because of late diagnosis and late treatment. The incidence of EH after extradural anaesthesia may be greater, as such a complication is not always reported.…”