Abstract

BERMEJO, M. et al. Epidural hematoma secondary to spinal anesthesia: Conservative treatment. Rev. Soc. Esp. Dolor [online]. 2004, vol.11, n.7, pp.72-75. ISSN 1134-8046.

Introduction: Epidural hematoma secondary to neuroaxial anesthesia is a rare complication, but highly relevant due to its clinical and medico-legal implications. According to some authors, its incidence can reach 1/190,000-1/200,000 for peridural punctures and 1/320,000 for spinal punctures. Early diagnosis and treatment within the first 6-12 hours is the main aspect related to its therapeutic management. However, in some cases such as the one reported here, surgery is not required and the patient can be managed with a conservative treatment. Clinical case: A 73-year-old patient, ASA IV, with a history of cirrhosis associated to portal hypertension, hypersplenism, COPD, obesity, hypertensive cardiopathy and tricuspid failure. He was scheduled for prostate alcoholization after ruling out surgery. Preoperative blood analyses showed a prothrombin activity of 80% and 90,000 platelets. Several failed attempts of spinal puncture were done, but general anesthesia was finally required with spontaneous ventilation through laryngeal mudpack, propofol, fentanyl and sevoflurane. Clinical manifestations appeared after 36 hours, with non-irradiated severe lumbar pain and plantar cutaneous areflexia. The presence of epidural hematoma at the L1-L4 level was confirmed through NMR. Given the absence of flaccid paraparesis, sphincter involvement or other sensitive-motor signs and after consultation with the Rachis Unit and the Neurology Service, a conservative treatment and an expecting attitude were agreed based on analgesia and strict neurological monitoring, both clinical and radiological. The evolution of the patient was favorable in the next days. Discussion: Certain clinical conditions can affect the appearance of hematoma after performing a central regional blockade: low molecular weight heparins, difficult punctures, previous vertebral surgery, hepatopathies, drugs, etc. Early surgical treatment based on decompression laminectomy is usually required and it is the treatment agreed in many cases, but in some patients such as this one, with no compressive symptoms, no progression of symptoms or a rapid improvement of symptoms, a conservative treatment based on analgesia and corticotherapy can be decided, always with a strict control in order to allow a quick intervention if there is a negative event in the evolution of the patient.

Keywords : Epidural hematoma; Spinal anesthesia; Conservative treatment.

        · abstract in Spanish     · text in Spanish     · Spanish ( pdf )