Page 42 - CASA Bulletin of Anesthesiology 2019 Vol 6 No 5

CASA Bulletin of Anesthesiology

At 4 .5 hr after capping the catheter, patient reported her right sided numbness has resolved,
distal muscle strength and sensation now appeared to be back to baseline, however left side hip
flexion remained diminished. At this time, both neurosurgery and primary surgical teams had
seen the patient and offered reassurance and continued monitoring .

7.5hrs after capping the catheter, patient’s left hip flexion remained weak. After consulting
with on-call radiologist, patient was sent to MRI . Imaging revealed hematoma from T2-T11
with worst compression at T7 . Patient was taken into OR for emergent thoracic T5 to T8 lami-
nectomy and hematoma evacuation .

Immediately postop, patient demonstrated full strength in all extremities, sensation intact to
light touch in all extremities with exception of some patch mild hyperesthesia distal bilateral
lower extremities .

Patient was discharged home after 11 days .

Discussion

Neuraxial anesthesia is frequently utilized as part of multimodal postoperative pain manage-
ment . Common however infrequent complications include PPD, neuropathy (2:10,000), cauda
equine syndrome (0 .2:10,000), paraplegia (0 .1:10,000), infection (0 .09:10,000) and hematoma
(0 .07:10,000) . 1 The incidence of spinal-epidural hematoma is 7:1,000,000 in non-OB popula-
tion and 6:1,000,000 in the OB population.2

As for causes of epidural hematoma, they can be wide ranging from trauma, neuraxial anes-
thesia (traumatic needle insertion), chronic pain procedures (facet blocks), surgical procedures,
coagulopathy, neoplasm and vascular malformations .3

General risk factors for bleeding during anticoagulation even with prophylactic dosing in-
clude increased age, history of GI bleed, aspirin use along with anticoagulation, female gender .4

There is no typical presentation of spinal epidural hematomas . There are case reports of
onset within 0 to 2 days of epidural placement to 12+hours following removal of catheter . The
initial symptom is typically pain at the site of most compression followed by progressive paral-
ysis. There might be both motor and sensory deficits and changes to bowel/bladder function.
However, the most important single factor is the motor blockade .5

Possible pathogenesis of epidural hematoma include epidural venous or arterial bleeding
from needle insertion, vascular malformations and/or catheter tip migration.6

42