Spinal epidural hematoma related to an epidural catheter in a cardiac surgery patient -A case report-

Abstract

The addition of thoracic epidural anesthesia to general anesthesia during cardiac surgery may have a beneficial effect on clinical outcome. However, epidural catheter insertion in a patient anticoagulated with heparin may increase the risk of epidural hematoma. We report a case of epidural hematoma in a 55-year-old male patient who had a thoracic epidural placed under general anesthesia preceding uneventful mitral valve replacement and tricuspid valve annular plasty. During the immediate postoperative period and first postoperative day, prothrombin time (PT) and activate partial thromboplastin time (aPTT) were mildly prolonged. On the first postoperative day, he complained of motor weakness of the lower limbs and back pain. An immediate MRI of the spine was performed and it revealed an epidural hematoma at the T5-6 level. Rapid surgical decompression resulted in a recovery of his neurological abnormalities to near normal levels. Management and preventing strategies of epidural hematoma are discussed.

Benefits and risks of epidural analgesia in cardiac surgery

“…We identified 25 epidural haematomas in cardiac surgery (five from published reports, [12][13][14][15][16] four from grey literature 9 17 and further 16 from the anonymous web survey) from a total of 14 countries: Belgium (1), Brazil (1), France (1), Germany (2), India (2), Italy (1), Japan (2), Korea (1), Malaysia (1), Russia (3), Sweden (2), Turkey (1) United Kingdom (3), and United States (4). The source and location for the haematomas are shown in Table 2.…”

Epidural catheterization in cardiac surgery: The 2012 risk assessment

“…The 2 nd case of catheter-related epidural hematoma happened in 2011. [11] On the day of surgery, after induction of general anesthesia, an epidural catheter was placed. The patient, a 55-year-old man scheduled for the mitral valve replacement and tricuspid valvuloplasty, had stopped warfarin 7 days before surgery.…”

“…Bang [11] 2011 Korean J Anesthesiol Mitral valve replacement and tricuspid valve annular plasty (epidural hematoma at the T5-6 level) 1 Bottio [12] 2007 Heart Valve Dis Heart valve surgery 50…”

<p>Perioperative Pain Management for Median Sternotomy in a Patient on Chronic Buprenorphine/Naloxone Maintenance Therapy: Avoiding Opioids in Patients at Risk for Relapse</p>

“…However, there have been two recent case reports of epidural hematoma with the epidural placement for cardiac surgery. 27,28 The epidural hematomas developed on postoperative day 1 after post-operative anticoagulation was initiated. The epidural placements were both atraumatic and greater than 60 mins elapsed from epidural placement to systemic heparinization.…”