Spinal Epidural Hematoma After Removal of an Epidural Catheter

Abstract

We report a case of spinal epidural hematoma after removal of an epidural catheter. The patient had no background of anticoagulant therapy or coagulopathy; sudden severe back pain occurred immediately after removal of the catheter. The chance of this occurring is estimated to be between 1:150,000 and 1:190,000. We studied 40 previous reports from 1952 to 2000, and we also investigated anticoagulant therapy and pathologic states, puncture difficulties and bleeding at the point of insertion, and its onset. In 23 cases (57.5%), anticoagulant therapy had been performed, and in 5 cases (12.5%), coagulopathy or liver dysfunction had been recognized. In 20 cases (50%), the initial symptoms were recognized within 24 hours after removal of the epidural catheter. Although spinal epidural hematoma is a very rare condition, it is a serious complication of continuous epidural anesthesia.

Spinal epidural hematoma following epidural catheter removal during antiplatelet therapy with cilostazol

“…So suffi cient education/ knowledge of epidural catheter removal is important. Miyazaki et al [15] reported that the initial symptoms of SEH were recognized within 24 h after the removal of an epidural catheter in 50% of 40 patients with SEH. If a patient presents with symptoms suggesting spinal cord compression after epidural catheter removal, SEH formation should be suspected.…”

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“…Additionally, epidural anesthesia has potential complications such as epidural hematoma, spinal cord injury, and high levels of anesthesia [17][18][19].…”

Spontaneous Recovery of Paraplegia Caused by Spinal Epidural Hematoma after Removal of Epidural Catheter

“…Risk factors for SEH associated with epidural anesthesia are female sex, old age, a history of gastrointestinal bleeding, anticoagulant therapy, coagulopathy, hepatic dysfunction, and difficult or traumatic epidural catheterization and bleeding at the puncture site [2, 5, 13]. Even if bleeding occurs in the epidural space, it usually stops rapidly [13]; however, a large hematoma may accumulate in the epidural space of patients with coagulopathy or liver dysfunction and those taking anticoagulants [13]. Spinal epidural hematoma may occur in patients with normal clotting function [5, 13, 14].…”

“…Even if bleeding occurs in the epidural space, it usually stops rapidly [13]; however, a large hematoma may accumulate in the epidural space of patients with coagulopathy or liver dysfunction and those taking anticoagulants [13]. Spinal epidural hematoma may occur in patients with normal clotting function [5, 13, 14]. It may present when an epidural catheter is in situ or after its removal [2–10].…”