[Spinal epidural hematoma after spinal anesthesia using a 27-gauge spinal needle in a patient with normal coagulation...

A 76-year-old man underwent transurethral resection of bladder tumor under spinal anesthesia. Preoperative laboratory date showed normal platelet count (188,000 x microl(-1)) and normal coagulation profile (PT 11.4 sec, APTT 35.1 sec). Lumbar puncture was successfully performed at the L3-4 intervertebral space using a 27-gauge spinal needle with some technical difficulties. Nine hours after the operation, patient suddenly complained of pain from the buttocks to the thighs. Neither motor weakness nor sensory disturbance was found. Therefore conservative therapy was chosen with a diagnosis of transient neurologic symptoms (TNS). However, the subjective symptoms did improve. On the 6th postoperative day, magnetic resonance image (MRI) showed a large epidural hematoma from L1 to L4. On the 13th postoperative day, the subjective symptoms disappeared and MRI on the 17th postoperative day revealed the absence of the hematoma. We should keep in mind that epidural hematoma as well as TNS can occur after spinal anesthesia even with a very fine needle.