Canadian Journal of Anaesthesia

, Volume 44, Issue 3, pp 300–304 | Cite as

Epidural abscess after combined spinal-epidural block

  • Jens Schröter
  • Djamba wa Djamba
  • Volker Hoffmann
  • Alfons Bach
  • Johann Motsch
Clinical reports

Abstract

Purpose

We report the first case of abscess formation after combined spinal-epidural block (CSE). Penetation of the dura in CSE may constitute an addtional risk of subarachnoid spread of bacteria when post-puncture epidural infection is present.

Clinical Features

The combination of a spinal and a continuous epidural bkxk(CSE) using needle through needle technique was used in a 72-yr-old ran far reconstructive vascular surgery of the lower limb. On the fourth postoperative day the patient demonstrated back pain, fever, and exudation of pus from trie CSE-puncture site. An epidural abscess was diagnosed by magnetic resonance imaging and subsequently an emergency hemiarrinectomy was performed. Physical examination and surgery did not show evidence of bacterial spread into the subarachnoid space.

Conclution

Epidural abscess formation after CSE may increase the risk of bacterial spread into the subarachnoid space. In this case spontaneous exudation and surgical drainage of abscess material may have prevented intrathecal infection. Rapid diagnosis and treatment of an epidural abscess appears particulalry essential after CSE to prevent neurological sequelae.

Résumé

Objectif

Les auteurs rapportent un premier cas d’abcès consécutif à un bloc combiné spinal-épidural (CSE). Avec le CSE, la perforation de la dure-mère peut constituer un facteur additionnel de risque de transmission bactérianne en présence d’une infection épidurale consécutive à la ponction.

Éléments cliniques

Un bloc combiné spinal et rachidien (CSE) était installé avec la technique de la double aiguille chez un homme de 72 ans pour une Chirurgie de reconstruction vasculaire du membre inférieur. Quatre jours après l’intervention. il se plaignait de lombalgie, était fiévreux et du pus se formait au site de la ponction du CSE. Un diagnostic d’abcès épidural était porté grace à l’imagerie par résonance magnétique et, par la suite, une hémilaminectomie était réalisée en urgence. L’examen physique et l’exploration chirurgicale n’ont pas montré de transmission bactérienne dans l’espace sous-arachnoïdien.

Conclusion

La formation d’un abcès épidural après un bloc CSE peut augmenter le risque de transmission bactérienne dans l’espace sous-arachnoïden. Dans le cas présent l’exsudation spontanée et le drainage chirurgical pourraient avoir évité une infection intrathécale. Pour prévenir les séquelles neurologiques, un diagnostic pré coce et un traitement immédiat de l’abcès épidurat semblent tout fait indispensables.

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Copyright information

© Canadian Anesthesiologists 1997

Authors and Affiliations

  • Jens Schröter
    • 1
  • Djamba wa Djamba
    • 1
  • Volker Hoffmann
    • 1
    • 2
  • Alfons Bach
    • 1
  • Johann Motsch
    • 1
  1. 1.Department of AnaesthesiaUniversity of HeidelbergHeidelbergGermany
  2. 2.Department of Diagnostic RadiologyUniversity of HeidelbergHeidelbergGermany

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