Incidence of Spinal Epidural Abscess after Epidural Analgesia

Wang, Lars P.; Hauerberg, John; Schmidt, J. F.

doi:10.1097/00000542-199912000-00046

Cited by 266 publications

(168 citation statements)

References 15 publications

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“…16 Similarly, epidural abscesses are rare with epidural pain catheters, reported in 1:1930 cases. 17 Additionally, epidural abscesses are noted only in patients in whom the catheter remains for Ͼ3 days. 17 To further decrease the rates of these complications, we recommend proper sterile technique, minimizing procedural length, and avoidance of anticoagulants in the periprocedural period.…”

Section: Discussionmentioning

confidence: 99%

“…17 Additionally, epidural abscesses are noted only in patients in whom the catheter remains for Ͼ3 days. 17 To further decrease the rates of these complications, we recommend proper sterile technique, minimizing procedural length, and avoidance of anticoagulants in the periprocedural period. Also, looping the wire and catheter in the epidural space (as displayed in the figures) before advancing them cranially should limit epidural vessel injury by avoiding a relatively sharp leading edge.…”

Section: Discussionmentioning

confidence: 99%

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Large-Volume Blood Patch to Multiple Sites in the Epidural Space through a Single-Catheter Access Site for Treatment of Spontaneous Intracranial Hypotension

Griauzde¹,

Gemmete

Chaudhary³

et al. 2014

American Journal of Neuroradiology

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Large-Volume Blood Patch to Multiple Sites in the Epidural Space through a Single-Catheter Access Site for Treatment of Spontaneous Intracranial Hypotension

Griauzde¹,

Gemmete

Chaudhary³

et al. 2014

American Journal of Neuroradiology

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“…Their incidence is approximately 1:2,000 epidural catheter placements. 1,2 Patients can present with pain, fever, headache, or neck stiffness, typically four to ten days after catheter removal. Evaluation should focus on generalized signs of infection (fever, leukocytosis), a detailed neurological examination, and inspection of the catheter site for erythema, tenderness, swelling, or drainage.…”

Section: Discussionmentioning

confidence: 99%

“…The risk is higher with longer (> three days) duration, diabetes or other immunocompromised states, and low molecular weight heparin prophylaxis. 1 Additionally, it has been suggested that skin abnormalities may also increase the risk of EA. 5 Pruritic urticarial papules and plaques of pregnancy is an ill-defined cutaneous eruption of pruritic lesions, most commonly occurring in primigravidas in the third trimester.…”

Section: Discussionmentioning

confidence: 99%

Case report: Epidural abscess in a parturient with pruritic urticarial papules and plaques of pregnancy (PUPPP)

Cummings

Dolak

2006

Can J Anesth/J Can Anesth

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Purpose: To describe the risk factors for epidural abscess (EA) formation following epidural analgesia in a parturient with pruritic urticarial papules and plaques of pregnancy (PUPPP). Clinical Features: A 33 yr-old gravida 2 nulliparous patient at 36 weeks gestation presented with severe pre-eclampsia, and PUPPP (treated with prednisone). Magnesium prophylaxis was started and labour was induced. An epidural catheter was placed at the L 3-4 level using standard aseptic technique. Bupivacaine was incrementally injected to achieve a T 10 sensory level, and analgesia was maintained using a continuous infusion of 0.0625% bupivacaine with fentanyl. Nine days post-delivery, the patient developed back pain radiating to her right leg, but she was otherwise asymptomatic. She was afebrile; with a slightly tender, nonerythematous, non-draining, 1 cm nodule at the epidural catheter site. Motor and sensory examinations were normal at that time. However, the patient returned 24 hr later and further investigations revealed: WBC 17,800·mm . The magnetic resonance imaging demonstrated an EA at the L 3-4 level causing minimal cord compression. The patient underwent an emergency decompressive laminectomy. Cultures revealed methicillin-sensitive Staphylococcus aureus. Her pain improved, and she was discharged on the third postoperative day with a six-week course of iv ceftriaxone. Conclusion: Causative organisms for EAs include coagulasenegative Staphylococci, S. aureus, and Gram-negative bacilli. Infection can occur either hematogenously or by direct contamination during catheter placement. Risk factors include immunocompromised states and PUPPP, as with the case of this patient. Objectif : Décrire les facteurs de risque d'abcès péridural (AP) à la suite d'une analgésie péridurale chez une parturiente qui présente des papules et des plaques prurigineuses urticariennes de la grossesse (PPPUG). Éléments cliniques : Une femme de 33 ans, nullipare, secondigeste, a consulté pour une sévère pré-éclampsie et des PPPUG (traitées avec de la prednisone) à 36 semaines de grossesse. L'administration préventive de magnésium a été amorcée et le travail induit. Un cathéter péridural a été placé à L3-4 selon la tech

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“…Epidural analgesia in parturients is a rare cause of central nervous system infection with large survey studies showing a very low incidence of infection. [33][34][35][36][37] Indeed, one study suggested that repeated epidural anesthesia in the presence of infection might be safe! 38 For a Cesarean section in the setting of a fever, 55% of anesthesiologists would use spinal anesthesia for delivery, with 27% of UBAs and 41% of CBAs using general anesthesia.…”

Section: Fever and Epidural Analgesia And Anesthesiamentioning

confidence: 99%

Obstetric anesthesia practice in Canada

Breen

McNeil

Dierenfield

2000

Can J Anesth/J Can Anesth

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Purpose: To describe obstetric anesthesia in Canada as practiced in 1997: to identify practices at variance with the literature and the opinions of experts: and to identify questions for future research.Methods: In 1997, a detailed postal questionnaire asking about the practice of obstetric anesthesia was mailed to all 1,539 specialist anesthesiologist members of the Canadian Anaesthetists' Society residing in Canada. Nonresponders were mailed a second questionnaire three months later.Results: There were 865 completed questionnaires returned for analysis (56.2%). Of these, 522 anesthesiologists practiced obstetric anesthesia (60.3%). The data were subdivided into those from anesthesiologists with a full or part-time university based practice (40.1%) and those from a community based practice (59.9%). University based and community-based anesthesiologists have very similar patterns of practice. Specific areas where anesthesia practice was different from current recommendations included: (1) information provided when obtaining consent for labour epidural analgesia, (2) use of opioids and local anesthetics for initiation of epidural analgesia, (3) use of coagulation testing in preeclampsia, (4) the common use of cutting spinal needles, (5) use of neuraxial morphine and nonsteroidal anti-inflammatory agents after Cesarean deliveries, (6) optimal treatment of neuraxial opioid side effects, (7) when to insert an endotracheal tube for general anesthesia after delivery, and (8) withdrawing epidural catheters through epidural needles.Conclusions: This survey presents reference data on the practice of obstetric anesthesia in Canada in 1997. Anesthesiologists with university affiliation have very similar practices to those without university affiliations.Objectif: Décrire l'anesthésie obstétricale pratiquée au Canada en 1997; identifier les pratiques qui diffèrent des pratiques documentées et des opinions d'experts et proposer des sujets de recherches ultérieures.Méthode : En 1997, un questionnaire détaillé sur la pratique de l'anesthésie obstétricale a été posté aux 1 539 anesthésiologistes membres de la Société canadienne des anesthésiologistes résidant au Canada. Trois mois plus tard, un second questionnaire a été posté à ceux qui n'avaient pas encore répondu.Résultats : Il y a eu 865 questionnaires remplis et analysés (56,2 %). De ce nombre, 522 provenaient d'anesthé-siologistes pratiquant l'anesthésie obstétricale (60,3 %). Les données ont été subdivisées selon le lieu de pratique, en milieu universitaire à temps complet ou partiel (40,1 %) ou en d'autres centres (59,9 %). Les modèles de pratique étaient très similaires. Certaines activités spécifiques différaient des recommandations courantes : 1) l'information fournie pour obtenir le consentement à l'analgésie épidurale pendant le travail, 2) l'usage d'opioïdes et d'anesthésiques locaux pour amorcer l'analgésie épidurale, 3) l'utilisation d'épreuve de coagulation en préé-clampsie, 4) l'usage courant d'aiguilles rachidiennes tranchantes, 5) l'administration neuraxiale...

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Incidence of Spinal Epidural Abscess after Epidural Analgesia

Cited by 266 publications

References 15 publications

Large-Volume Blood Patch to Multiple Sites in the Epidural Space through a Single-Catheter Access Site for Treatment of Spontaneous Intracranial Hypotension

Large-Volume Blood Patch to Multiple Sites in the Epidural Space through a Single-Catheter Access Site for Treatment of Spontaneous Intracranial Hypotension

Case report: Epidural abscess in a parturient with pruritic urticarial papules and plaques of pregnancy (PUPPP)

Obstetric anesthesia practice in Canada

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