EPIDURAL HEMATOMA FOLLOWING SINGLE-SHOT E PIDURAL-ANESTHESIA

The formation of an epidural or subdural haematoma is a well-known but very rare complication when anaesthetic procedures are conducted near the spinal cord. The major reasons are impaired blood coagulation and the trauma of puncture, which represents the initiating factor and de termines the extent of the vascular lesion, while defective coagulatio n may cause the bleeding to continue. We report on a 30-year-old slend er female patient of ASA group II undergoing epidural anaesthesia at L 3/4 with a 19-gauge Crawford needle for an ankle joint injury. Unexpec ted puncture difficulties made several approaches necessary. Preventio n of thrombosis with low-molecular heparin was not started preoperativ ely but 8 h following the intervention. On the first postoperative day the patient was mobilized and, in spite of the repeated punctures, th ere were no complaints until the fourth postoperative day. Subsequentl y, sudden significant complaints occurred, first suggesting infection near the spinal cord. Immediate magnetic resonance imaging revealed an epidural haematoma, which did not require intervention. Puncture of t he spinal fluid was not performed. Laboratory analysis of coagulation showed a prothrombin time of 56%; PTT was normal with 36 s. Following three days of symptomatic therapy, the complaints had improved markedl y, so that mobilization could be started again. For another 10 days th e patient had a minor diffuse sensation of pressure when moving the lu mbar spine in this region. Subsequently, there were no complaints at a ll, as proved by an investigation one year later. Unfortunately, the p atient refused to undergo another MRT at that time. In the present cas e the haematoma was caused by tissue trauma due to several puncture at tempts. The prognosis largely depends on early recognition of the symp toms, which in our case became manifest only after several days, as we ll as the immediate employment of special diagnostic procedures and, i f necessary, surgical intervention. At present, it is not possible to conduct a statistical analysis on the question of whether there is a h igher incidence of haematoma in single-shot anaesthesia than in contin uous anaesthesia.