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Unexpected epidural hematoma after epidural block procedure in patient with no risk factor
Department of Anesthesiology and Pain Medicine, Chungnam National University Hospital1
Department of Anesthesiology and Pain Medicine, College of Medicine, Chungnam National University2
INTRODUCTION
Epidural hematoma is a rare complication of pain control procedures. It is also leading to acute myelopathy which sometimes necessitates surgical evacuation. Anatomical factors such as vascular malformations or pharmacological factors such as taking antiplatelet drugs or anticoagulants are known risk factors for epidural hematoma. It may also occur rarely in patients with no history of coagulopathy and anticoagulative medications.
CASE REPORT
A 78-year-old female patient visited with back pain that had begun 2 years ago and worsened 3 months ago. Patient was taking medication for hypertension and dyslipidemia, was not taking aspirin, other antiplatelet drugs, or anticoagulants. The patient visited the orthopedic surgery department and was referred to the Pain Clinic after diagnosis of T8, T10 Compression Fracture. Patient performed Thoracic epidural block for pain relief. The procedure was successfully completed, and the patient returned home without any problems after resting about 40 minutes that to observe the improvement of symptoms and the presence or absence of side effects. About 3 hours after the patient returned home, patient complained over the phone that the lower extremities felt increasingly anesthetized. Although it is possible that it was a temporary reaction due to the drug after the procedure, patient advised to visit the emergency center if the symptoms persist or worsen. About 10 hours after the procedure, the patient came to the emergency center and complained of decreased sensory and motor functions in both lower extremities. After MRI scanning, epidural hematoma was confirmed and patient had emergency hematoma evacuation. The patient had sequelae as Conus medullaris syndrome.
CONCLUSION
Spinal epidural hematoma is known to be very rare in patients without blood coagulation disorder. According to the literature, it’s known that the incidence is 1 in 150,000 after epidural block. In some literature, it has been reported that spontaneous epidural hematoma also occurs for no obvious reason. In this case, the patient had no risk of causing epidural hematoma. The patient had surgery about 16 hours after the procedure, and the sequelae remain. The occurrence of unpredictable epidural hematoma cannot be prevented, but it is necessary for the patient to visit the emergency center as soon as possible to receive treatment.
Epidural hematoma is a rare complication of pain control procedures. It is also leading to acute myelopathy which sometimes necessitates surgical evacuation. Anatomical factors such as vascular malformations or pharmacological factors such as taking antiplatelet drugs or anticoagulants are known risk factors for epidural hematoma. It may also occur rarely in patients with no history of coagulopathy and anticoagulative medications.
CASE REPORT
A 78-year-old female patient visited with back pain that had begun 2 years ago and worsened 3 months ago. Patient was taking medication for hypertension and dyslipidemia, was not taking aspirin, other antiplatelet drugs, or anticoagulants. The patient visited the orthopedic surgery department and was referred to the Pain Clinic after diagnosis of T8, T10 Compression Fracture. Patient performed Thoracic epidural block for pain relief. The procedure was successfully completed, and the patient returned home without any problems after resting about 40 minutes that to observe the improvement of symptoms and the presence or absence of side effects. About 3 hours after the patient returned home, patient complained over the phone that the lower extremities felt increasingly anesthetized. Although it is possible that it was a temporary reaction due to the drug after the procedure, patient advised to visit the emergency center if the symptoms persist or worsen. About 10 hours after the procedure, the patient came to the emergency center and complained of decreased sensory and motor functions in both lower extremities. After MRI scanning, epidural hematoma was confirmed and patient had emergency hematoma evacuation. The patient had sequelae as Conus medullaris syndrome.
CONCLUSION
Spinal epidural hematoma is known to be very rare in patients without blood coagulation disorder. According to the literature, it’s known that the incidence is 1 in 150,000 after epidural block. In some literature, it has been reported that spontaneous epidural hematoma also occurs for no obvious reason. In this case, the patient had no risk of causing epidural hematoma. The patient had surgery about 16 hours after the procedure, and the sequelae remain. The occurrence of unpredictable epidural hematoma cannot be prevented, but it is necessary for the patient to visit the emergency center as soon as possible to receive treatment.
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