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Epidural abscesses.

S Grewal1, G Hocking, J A W Wildsmith

  • 1Nuffield Department of Anaesthesia, John Radcliffe Hospital, Oxford, UK. sarah.grewal@tiscali.co.uk

British Journal of Anaesthesia
|January 25, 2006
PubMed
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Epidural abscess, a serious complication of central nerve blocks, is becoming more frequent. Early diagnosis and prevention through strict aseptic techniques are crucial to minimize patient harm.

Area of Science:

  • Anesthesiology
  • Neurosurgery
  • Infectious Diseases

Background:

  • Epidural abscess was historically rare but is increasingly reported as a complication of central nerve blocks.
  • Risk factors like compromised immunity and spinal issues are common in patients with epidural abscess.
  • The incidence of epidural abscess following central nerve blocks ranges from 1:1,000 to 1:100,000.

Purpose of the Study:

  • To review risk factors, pathogenesis, clinical features, and outcomes of epidural abscess.
  • To provide recommendations for anesthetic practice to minimize the risk of epidural abscess.
  • To highlight the importance of early diagnosis and prevention strategies.

Main Methods:

  • Systematic literature search of EMBASE, PUBMED, and MEDLINE databases (1966-2004).

Related Experiment Videos

  • Inclusion of studies identified through reference list screening.
  • Analysis of spontaneous and central nerve block-associated epidural abscess cases.

    • Main Results:

    • Spontaneous epidural abscess occurs in 0.2-1.2 per 10,000 hospital admissions annually.
    • Clinical presentation often includes vague symptoms like fever and back pain preceding neurological deficits.
    • Effective treatment requires prompt surgical drainage and high-dose parenteral antibiotics.

    Conclusions:

    • Epidural abscess is a potentially catastrophic complication of central nerve blocks.
    • Early diagnosis and intervention are vital to prevent permanent neurological damage.
    • Primary prevention through rigorous aseptic techniques is paramount; further incidence surveys are needed.