EPIDURAL ABSCESS AFTER COMBINED SPINAL-EPIDURAL BLOCK

Purpose: We report the first case of abscess formation after combined spinal-epidural block (CSE). Penetration of the dura in CSE may consti tute an additional risk of subarachnoid spread of bacteria when post-p uncture epidural infection is present. Clinical Features: The combinat ion of a spinal and a continuous epidural block (CSE) using a needle t hrough needle technique was used in a 72-yr-old man for reconstructive vascular surgery of the lower limb. On the fourth postoperative day t he patient demonstrated back pain, fever and exudation of pus from the CSE-puncture site. An epidural abscess was diagnosed by magnetic reso nance imaging and subsequently an emergency hemiaminectomy was perform ed. Physical examination and surgery did not show evidence of bacteria l spread into the subarachnoid space. Conclusion: Epidural abscess for mation after CSE may increase the risk of bacterial spread into the-su barachnoid space. In this case spontaneous exudation and surgical drai nage of abscess material may have prevented intrathecal infection. Rap id diagnosis and treatment of an epidural abscess appears particularly essential after CSE to prevent neurological sequelae.