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Epidural anaesthesia and spinal haematoma
1Department of Anaesthesiology and Intensive Care Medicine, Hospital of the Christian-Albrechts-University of Kiel, Germany. H.WULF@ANAESTHESIE.UNI-KIEL.DE
Canadian Journal of Anaesthesia = Journal Canadien D'Anesthesie
|December 1, 1996
Summary
Spinal epidural hematomas are rare complications of epidural anesthesia. Preexisting coagulopathies and intravenous heparin therapy are primary risk factors, while ankylosing spondylitis is a newly identified risk factor.
Area of Science:
- Anesthesiology
- Neurology
- Hematology
Background:
- Spinal epidural hematoma is a rare but severe complication of epidural anesthesia.
- Prompt diagnosis and management are crucial to prevent permanent neurological deficits.
Purpose of the Study:
- To comprehensively review case reports of spinal hematomas associated with epidural anesthesia.
- To identify predominant risk factors and estimate the incidence of this complication.
Main Methods:
- Systematic review of case reports from 1966 to 1995.
- Inclusion of data from Medline searches and cross-referencing with previous reviews.
Main Results:
- Fifty-one cases of spinal hematomas linked to epidural anesthesia were identified.
- Predominant risk factors included preexisting coagulopathy (14 cases) and intravenous heparin therapy (18 cases).
- Difficult catheter insertion was noted in 21 cases; ankylosing spondylitis was a newly identified risk factor.
Conclusions:
- Coagulopathies and anticoagulant therapies, particularly full heparinization, are major risk factors.
- Low-dose heparin thromboprophylaxis and NSAID use were rarely associated with spinal bleeding.
- The estimated incidence of spinal hematoma following epidural anesthesia is approximately 1:190,000 procedures.