Delayed retroperitoneal haematoma after failed lumbar plexus block.

Area of Science:

• Anesthesiology
• Neurosurgery
• Vascular Surgery

Background:

• Lumbar plexus blocks are utilized for postoperative analgesia following hip replacement surgery.
• Neuraxial and peripheral nerve blockade techniques are essential in modern surgical pain management.
• Thromboprophylaxis is a standard postoperative care measure to prevent thromboembolic events.

Observation:

• A 72-year-old patient underwent an attempted posterior lumbar plexus block for hip replacement analgesia, which was unsuccessful.
• Following the failed block, a fascia iliaca compartment block was performed.
• Postoperatively, the patient received enoxaparin followed by phenylindanedione for thromboprophylaxis.

Findings:

• The patient was re-admitted two weeks post-surgery with a significant lower limb motor deficit.
• A large left retroperitoneal hematoma was diagnosed, necessitating a blood transfusion.
• The complication occurred in the context of the patient receiving thromboprophylaxis medication.

Implications:

• Clinicians must exercise extreme caution when performing lumbar plexus blocks in patients on thromboprophylaxis.
• Awareness of the potential for retroperitoneal hematoma formation is critical for patient safety.
• Alternative analgesia techniques or modified anticoagulation protocols may be considered in high-risk patients.