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Canadian Journal of Anaesthesia

, Volume 43, Issue 12, pp 1260–1271 | Cite as

Epidural anaesthesia and spinal haematoma

  • Hinnerk WulfEmail author
Brief Review

Abstract

Purpose

Haematoma formation in the spinal canal due to epidural anaesthesia is a very rare but serious complication. This paper presents a comprehensive review of case reports.

Source

Sampling of case reports over a 10 yr period, medline® -research (1966–1995) and cross-check with former reviews.

Findings

Fifty-one confirmed spinal haematomas associated with epidural anaesthesia were found. Most were related to the insertion of a catheter, a procedure that was graded as difficult or traumatic in 21 patients. Other risk factors were: fibrinolytic therapy (n = 2), previously unknown spinal pathology (n = 2), low molecular weight heparin (n = 2), aspirin or other NSAID (n = 3), epidural catheter inserted during general anaesthesia (n = 3), thrombocytopenia (n = 5), ankylosing spondylitis (n = 5), preexisting coagulopathy (n = 14), and intravenous heparin therapy (n = 18).

Conclusion

Coagulopathies or anticoagulant therapy (e.g., full heparinization) were the predominant risk factors, whereas low-dose heparin thromboprophylaxis or NSAID treatment was rarely associated with spinal bleeding complications. Ankylosing spondylitis was identified as a new, previously unreported risk factor. Analysis of reported clinical practice suggests an incidence of haematoma of 1:190,000 epidurals.

Key words

anaesthetic technique: epidural analgesics: NSAID complications: haematoma, spinal, coagulopathy, anticoagulation 

Résumé

Objectif

L’hématome du canal rachidien provoqué par l’anesthésie épidurale constitue une complication très rare tout en étant très grave. Cet article présente une revue détaillée des cas rapportés.

Source

Les observations rapportées sur une période de dix ans, une recherche dans Medline® (1966–1995) et un recoupement avec les articles de revue antérieurs.

Constatations

Cinquante et une observations d’hématomes rachidiens prouvés associés à l’anesthésie épidurale ont été trouvées. La plupart des hématomes étaient liés à l’insertion d’un cathéter, technique ayant été jugée difficile ou traumatique chez 21 patients: la thérapie fibrinolytique (n = 2), l’aspirine ou un autre A1NS (n = 3), un cathéter épidural inséré pendant une anesthésie générale (n = 3), la thrombocytopénie (n = 5), la spondylite ankylosante (n = 5), la coagulopathie préexistante (n = 14) et l’héparinothérapie intraveineuse (n = 18).

Conclusion

La coagulothérapie et l’anticoagulothérapie (i.e., l’héparinisation complète) ont été les facteurs de risque prédominants alors que la thromboprophylaxie à l’héparine à faible dose et les traitement aux AINS ont été rarement associés à des complications hémorragiques rachidiennes. La spondylite ankylosante a été identifée comme un nouveau facteur de risque jusque là non signalé. L’analyse des observations suggère que l’incidence de l’hématome est de 1:190,000.

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Copyright information

© Canadian Anesthesiologists 1996

Authors and Affiliations

  1. 1.Department of Anaesthesiology and Intensive Care MedicineHospital of the Christian-Albrechts-University of KielKielGermany

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