Neuraxial Hematoma after Epidural Anesthesia. Is It Possible to Prevent or Detect It? Report of Two Cases

Souza, Rita de Cássia de; Andrade, Luiz Otávio Fernandes; Silva, Joaquim Belchior; Silva, Luiz Antônio Carneiro da

doi:10.1016/s0034-7094(11)70026-5

Cited by 2 publications

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“…11,18 Epidural iğneyle sinir kökü travmasının, ilgili dermatomda keskin yayılan ağrı veya parestezi gibi belli semptomları vardır. 14,15 Ancak popu-lasyona göre sıklığı değişmektedir. Ortopedik cerrahi yapılan yaşlı hastalarda sıklığı 1:3600-1:29.000 olarak saptanmıştır.…”

Section: Bradikardi Ve Kardiyak Arrestunclassified

“…Ancak tanımlanmış risk faktörlerine rağmen nöroaksiyal hematomların %40'ının nedeni bulunamamıştır. 14 Spinal hematomun standart tedavisinde, semptomlar ortaya çıktıktan sonra, 12 saat içinde MR ile tanı konmalı ve erken dekompresyon sağlanmalıdır. Ancak bazı vakalarda noroşirurji ile işbirliği içinde belirtiler ve semptomlar takip edilerek, konservatif yaklaşım uygulanmıştır.…”

Section: Bradikardi Ve Kardiyak Arrestunclassified

“…Sinir hasarının MR bulguları; spinal kord veya sinir kökü ödemi, hasarlı bölgede hematom gelişmesi olarak belirtilebilir. 14 Spinal hematom epidural anestezinin nadir ama ciddi bir komplikasyonudur. Kanama epidural venöz pleksus kaynaklı olması nedeniyle epidural boşlukta görülmektedir.…”

Section: Bradikardi Ve Kardiyak Arrestunclassified

“…Epidural anesteziye sekonder spinal hematom sıklığı literatürde, 1:168.000-1:190.000 arasında değişmektedir. 14,15 Spinal hematom, sıklıkla anti-koagülan kullanımı olan hastalarda gelişmektedir. 5,11 Bu nedenle, Rejyonel Anestezi Derneği anti-koagülan kullanan hastalarda rejyonel anestezi yönetimiyle ilgili önerilerde bulunmuştur.…”

Section: Bradikardi Ve Kardiyak Arrestunclassified

“…Ancak popu-Dicle Tıp Derg / Dicle Med J www.diclemedj.org Cilt / Vol 39, No 2, 320-324 nal kord hastalıkları( meduller kanal darlığı, ankilozan spondilit), karaciğer fonksiyon bozukluğu ve trombositopeni ile birlikte preeklampsi, hipertansiyon ve alkol kullanımı olarak belirtmişlerdir. Ancak tanımlanmış risk faktörlerine rağmen nöroaksiyal hematomların %40'ının nedeni bulunamamıştır 14. Spinal hematomun standart tedavisinde, semptomlar ortaya çıktıktan sonra, 12 saat içinde MR ile tanı konmalı ve erken dekompresyon sağlanmalıdır.…”

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Serious complications of epidural anesthesia

Doğru¹

2012

Dicle Med J

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ABSRACTEpidural anesthesia is a well-recognized and identified regional anaesthesia technique in anesthesia practice. First applied at sacral region in 1895 by Cathelin and today it has become a basic regional anaesthesia technique. Frequent application of epidural anesthesia has caused an increase at serious complications like bradycardia, cardiac arrest, neurologic and infective complications. But now, it has become a frequent practice for anesthesiologists under developments in practices and techniques.We aim to review serious complications of epidural anesthesia within current literatures.

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Serious complications of epidural anesthesia

Doğru¹

2012

Dicle Med J

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Neuraxial blocks and spinal haematoma: Review of 166 case reports published 1994–2015. Part 1: Demographics and risk-factors

Lagerkranser

2017

Scandinavian Journal of Pain

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AbstractBackgroundBleeding into the vertebral canal causing a spinal haematoma (SH) is a rare but serious complication to central neuraxial blocks (CNB). Of all serious complications to CNBs such as meningitis, abscess, cardiovascular collapse, and nerve injury, neurological injury associated with SH has the worst prognosis for permanent harm. Around the turn of the millennium, the first guidelines were published that aimed to reduce the risk of this complication. These guidelines are based on known risk factors for SH, rather than evidence from randomised, controlled trials (RCTs). RCTs, and therefore meta-analysis of RCTs, are not appropriate for identifying rare events. Analysing published case reports of rare complications may at least reveal risk factors and can thereby improve management of CNBs. The aims of the present review were to analyse case reports of SH after CNBs published between 1994 and 2015, and compare these with previous reviews of case reports.MethodsMEDLINE and EMBASE were used for identifying case reports published in English, German, or Scandinavian languages, using appropriate search terms. Reference lists were also scrutinised for case reports. Twenty different variables from each case were specifically searched for and filled out on an Excel spreadsheet, and incidences were calculated using the number of informative reports as denominator for each variable.ResultsAltogether 166 case reports on spinal haematoma after CNB published during the years between 1994 and 2015 were collected. The annual number of case reports published during this period almost trebled compared with the two preceding decades. This trend continued even after the first guidelines on safe practice of CNBs appeared around year 2000, although more cases complied with such guidelines during the second half of the observation period (2005–2015) than during the first half. Three types of risk factors dominated:(1)Patient-related risk factors such as haemostatic and spinal disorders, (2) CNB-procedure-related risks such as complicated block, (3) Drug-related risks, i.e. medication with antihaemostatic drugs. Conclusions and implicationsThe annual number of published cases of spinal haematoma after central neuraxial blocks increased during the last two decades (1994–2015) compared to previous decades. Case reports on elderly women account for this increase.Antihaemostatic drugs, heparins in particular, are still major risk factors for developing post-CNB spinal bleedings. Other risk factors are haemostatic and spinal disorders and complicated blocks, especially “bloody taps”, whereas multiple attempts do not seem to increase the risk of bleeding. In a large number of cases, no risk factor was reported. Guidelines issued around the turn of the century do not seem to have affected the number of published reports. In most cases, guidelines were followed, especially during the second half of the study period. Thus, although guidelines reduce the risk of a post-CNB spinal haematoma, and should be strictly adhered to in every single case, they are no guarantee against such bleedings to occur.

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Neuraxial Hematoma after Epidural Anesthesia. Is It Possible to Prevent or Detect It? Report of Two Cases

Cited by 2 publications

References 16 publications

Serious complications of epidural anesthesia

Serious complications of epidural anesthesia

Neuraxial blocks and spinal haematoma: Review of 166 case reports published 1994–2015. Part 1: Demographics and risk-factors

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