Anaes Cases · Neuraxial anaesthesia
New back pain after an epidural — the epidural haematoma
The epidural haematoma long case — the new severe back pain + neurological deficit after an epidural in an anticoagulated patient, the urgent MRI, and the neurosurgical decompression.
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ANZCAFRCAABAEDAIC
Prompt
A 68-year-old man had a thoracic epidural for postoperative analgesia after bowel surgery. He is on prophylactic enoxaparin. 24 hours postoperatively he develops severe back pain and cannot move his legs. Discuss.
Presentation
A 68-year-old man had a thoracic epidural placed for postoperative analgesia after a colectomy. He is on enoxaparin 40 mg daily (started 12 hours after the epidural insertion). At 24 hours postoperatively, the nurse reports that he is complaining of severe lower-back pain and has noticed that he cannot move his legs. The epidural infusion is running.
References2ShowHide
- [1]Cook TM, et al. Major complications of central neuraxial block: report on the Third National Audit Project of the Royal College of Anaesthetists. British Journal of Anaesthesia, 2009.PMID 19139027
- [2]Horlocker TT, et al. Regional anesthesia in the patient receiving antithrombotic or thrombolytic therapy: American Society of Regional Anesthesia and Pain Medicine Evidence-Based Guidelines (Third Edition). Regional Anesthesia and Pain Medicine, 2010.PMID 20052816