Successful Percutaneous Drainage of Epidural Abscess with Epidural Needle and Catheter

Tabo, Etsuo; Ohkuma, Y; Kimura, Shigeo; Nagaro, Takumi; Aral, Tatsuru

doi:10.1097/00000542-199406000-00028

Cited by 40 publications

(24 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In all, there is a low incidence of infectious complications following anesthesiological procedures in the epidural and spinal spaces [25]. In this metaanalysis of 854 patients, there were 42 cases of SEA following catheter epidural anesthesia, nine following spinal anesthesia, and five following "single shot" injections into the epidural space (Table 1) [24,36,39,45,57,70,79,86,104,106,117,122,128,142,152,186,213,215,225,233,241,256,259,260,265,278,304,318,335,342,351,352,362,365,382,385].…”

Section: Pathogenesis and Risk Factorsmentioning

confidence: 96%

Spinal epidural abscess: a meta-analysis of 915 patients

Waldbaur²,

2000

View full text Add to dashboard Cite

Spinal epidural abscess (SEA) was first described in the medical literature in 1761 and represents a severe, generally pyogenic infection of the epidural space requiring emergent neurosurgical intervention to avoid permanent neurologic deficits. Spinal epidural abscess comprises 0.2 to 2 cases per 10,000 hospital admissions. This review intends to offer detailed evaluation and a comprehensive meta-analysis of the international literature on SEA between 1954 and 1997, especially of patients who developed it following anesthetic procedures in the spinal canal. In this period, 915 cases of SEA were published. This review is the most comprehensive literature analysis on SEA to date. Most cases of SEA occur in patients aged 30 to 60 years, but the youngest patient was only 10 days old and the oldest was 87. The ratio of men to women was 1:0.56. The most common risk factor was diabetes mellitus, followed by trauma, intravenous drug abuse, and alcoholism. Epidural anesthesia or analgesia had been performed in 5.5% of the patients with SEA. Skin abscesses and furuncles were the most common source of infection. Of the patients, 71% had back pain as the initial symptom and 66% had fever. The second stage of radicular irritation is followed by the third stage, with beginning neurological deficit including muscle weakness and sphincter incontinence as well as sensory deficits. Paralysis (the fourth stage) affected only 34% of the patients. The average leukocyte count was 15,700/microl (range 1,500-42,000/microl), and the average erythrocyte sedimentation rate was 77 mm in the first hour (range 2-50 mm). Spinal epidural abscess is primarily a bacterial infection, and the gram-positive Staphylococcus aureus is its most common causative agent. This is true also for patients who develop SEA following spinal anesthetics. Magnetic resonance imaging (MRI) displays the greatest diagnostic accuracy and is the method of first choice in the diagnostic process. Myelography, commonly used previously to diagnose SEA, is no longer recommended. Lumbar puncture to determine cerebrospinal fluid protein concentrations is not needed for diagnosis and entails the risk of spreading bacteria into the subarachnoid space with consequent meningitis; therefore, it should not be performed. The therapeutic method of choice is laminectomy combined with antibiotics. Conservative treatment alone is justifiable only for specific indications. Laminotomy is a therapeutic alternative for children. The mortality of SEA dropped from 34% in the period of 1954-1960 to 15% in 1991-1997. At the beginning of the twentieth century, almost all patients with SEA died. Parallel to improvements in the mortality rate, today more patients experience complete recovery from SEA. The prognosis of patients who develop SEA following epidural anesthesia or analgesia is not better than that of patients with noniatrogenic SEA, and the mortality rate is also comparable. The essential problem of SEA lies in the necessity of early diagnosis, because only timely treatment is able to av...

show abstract

Section: Pathogenesis and Risk Factorsmentioning

confidence: 96%

Spinal epidural abscess: a meta-analysis of 915 patients

Waldbaur²,

2000

View full text Add to dashboard Cite

show abstract

“…In the case report of Tabo et al [12], two cases of epidural abscess occurred in patients who were treated at a pain clinic. In these cases, each abscess was removed through a method in which yellow pus was drained through 3 Tuohy needles and a catheter and washed with saline solution.…”

Section: Discussionmentioning

confidence: 98%

“…It is believed that immediate decompression within 36 hours is linked to good prognosis [8]. However, according to Cai et al reported for a few cases [11][12][13][14].…”

Section: Discussionmentioning

confidence: 99%

Drainage of an acute spinal epidural hematoma that developed without risk factors in the thoracic spine using epidural needle -A case report-

et al. 2017

View full text Add to dashboard Cite

Epidural hematoma after epidural block is a rare complication in healthy patients without risk factor. However, this rare disease can lead to neurological symptoms or paralysis. It is usually treated with surgical drainage. Herein we report a case of acute thoracic epidural hematoma associated with neurologic symptoms after epidural block in a healthy male without risk factors. We performed drainage of the epidural hematoma using 18-gauge Tuohy needle without surgical intervention. The patient's neurological symptoms and pain were relieved. He was discharged without sequelae. CASE REPORTA 73-year-old male patient who visited with intermittent intolerable sharp and lancinating pain over the left anterior chest wall and the back for one month. He received 300 mg/day of gabapentin and 1,500 mg/day of valacyclovir orally for 7 days following diagnosis with acute herpes zoster at a local private clinic. The patient did not have any unusual history, including family history and surgical history. He had no systemic diseases such as hypertension, diabetes, and so on.His height and weight were 172 cm and 59 kg, respectively.Results of his blood tests such as activated partial thromboplastin time, prothrombin time, and platelet count all showed normal ranges.Physical examination revealed allodynia and hyperalgesia over the left T4 and T5 dermatomes. He complained severe pain in the affected area with a score of 8 or 9 on visual analog scale (VAS) where 0 indicated "no pain" and 10 indicated "the strongest pain imaginable." In particular, he was unable to sleep at night due to severe pain which interfered with his daily life.Under the diagnosis of post-herpetic neuralgia, the patient ￭Case Report￭

show abstract

“…(3,4,6). However, MRI has now become the main diagnostic tool, eliminating the need for dural puncture and has also been used successfully in a patient allergic to contrast material (19)(20)(21)(22)(23)(24)(25)(26). Narrowing of the spinal canal in the T2 weighted MR image is important information, suggesting an epidural abscess.…”

Section: Discussionmentioning

confidence: 99%

Spinal Epidural Abscess Associated with Epidural Catheterization: Report of a Case and a Review of the Literature

Okano¹,

Kondo²,

Tsuchiya³

et al. 1999

Japanese Journal of Clinical Oncology

View full text Add to dashboard Cite

We describe a 53-year-old man who developed a catheter-related epidural abscess 8 days after left upper lobectomy for lung cancer. Methicillin-resistant Staphylococcus aureus (MRSA) was detected in a culture of the epidural pus. Magnetic resonance imaging was essential for the diagnosis of epidural abscess and for determining the extent of spread. The patient was treated by laminectomy and administration of appropriate antibiotics, with almost complete recovery, except for urinary retention. A literature search yielded 29 additional cases of catheter-related epidural abscess. The median duration of catheterization was 4 days and the median time to onset of the clinical symptoms after catheter placement was 8 days. Eleven of the 30 patients had some underlying disorders, including malignancy or herpes zoster, or were receiving steroids. Nine of the 10 patients with thoracic epidural abscess had persistent neurological deficits, whereas 12 of the 15 patients with lumbar epidural abscess showed a full recovery after treatment. Surgical decompression was not required in six patients without significant neurological deficits, who recovered following antibiotic treatment (four patients) or percutaneous drainage (two patients). Thoracic catheters are associated with a disproportionately high incidence of epidural abscess and persistent neurological sequelae following treatment.

show abstract

Successful Percutaneous Drainage of Epidural Abscess with Epidural Needle and Catheter

Cited by 40 publications

References 0 publications

Spinal epidural abscess: a meta-analysis of 915 patients

Spinal epidural abscess: a meta-analysis of 915 patients

Drainage of an acute spinal epidural hematoma that developed without risk factors in the thoracic spine using epidural needle -A case report-

Spinal Epidural Abscess Associated with Epidural Catheterization: Report of a Case and a Review of the Literature

Contact Info

Product

Resources

About