Page 41 - CASA Bulletin of Anesthesiology 2019 Vol 6 No 5

Vol.6, No.5, 2019

病例报告

Spinal Epidural Hematoma with

Indwelling Epidural Catheter

Mian Shen, MD
Andrew Mannes, MD, Chief
Department of Perioperative Medicine
Clinical Center, NIH
Bethesada, MD

Case Report

67 year old woman with a history well controlled hypertension, recurrent gastrointestinal
stromal tumor (GIST), s/p resection in 2009 and Gleevec treatment since 2013 . She was sched-
uled for distal gastrectomy with Billroth II reconstruction and partial transverse colectomy with
primary anastomosis .

On the day of surgery, patient underwent uneventful single pass epidural placement at T8-T9
interspace, LOR to saline at 6.5cm, the catheter was advanced easily and taped at 11cm at the
skin . Negative test dose of 3cc 1 .5% lidocaine with epi and demonstrated adequate sensory lev-
el at T6. 5000 U SC heparin was given about 30minutes after epidural placement. After 2.5hrs,
surgery was completed with minimal blood loss . Epidural was bolused with 0 .25% Bupivacaine
intermittently throughout the surgery . Patient was extubated and transported to PACU then to

floor.

On POD1, patient reported satisfactory pain relief, no sensory deficits, and baseline strength
in all extremities. Heparin 5000U was given SC 16hrs post op and q8 thereafter.

On POD2, patient ambulated without difficulty in the morning. However by 5pm, she noted
numbness on the right side . Upon examination, it was noted she had diminished bilateral hip
flexion and paresthesia in RLE. Decision was made to withdraw 1cm of epidural catheter and
decrease epidural infusion by half (4cc/hr) .

2 hours later, patient reported slowly decreasing block on the right but the hip flexion re-
mained diminished . Epidural infusion was stopped and capped .

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