Epidural anaesthesia and spinal haematoma. Wulf, H Canadian journal of anaesthesia = Journal canadien d'anesthésie, 43(12):1260–1271, December, 1996.
doi  abstract   bibtex   
PURPOSE Haematoma formation in the spinal canal due to epidural anaesthesia is a very rare but serious complication. This paper presents a comprehensive review of case reports. SOURCE Sampling of case reports over a 10 yr period, medline-research (1966-1995) and cross-check with former reviews. FINDINGS Fifty-one confirmed spinal haematomas associated with epidural anaesthesia were found. Most were related to the insertion of a catheter, a procedure that was graded as difficult or traumatic in 21 patients. Other risk factors were: fibrinolytic therapy (n = 2), previously unknown spinal pathology (n = 2), low molecular weight heparin (n = 2), aspirin or other NSAID (n = 3), epidural catheter inserted during general anaesthesia (n = 3), thrombocytopenia (n = 5), ankylosing spondylitis (n = 5), preexisting coagulopathy (n = 14), and intravenous heparin therapy (n = 18). CONCLUSION Coagulopathies or anticoagulant therapy (e.g., full heparinization) were the predominant risk factors, where-as low-dose heparin thromboprophylaxis or NSAID treatment was rarely associated with spinal bleeding complications. Ankylosing spondylitis was identified as a new, previously unreported risk factor. Analysis of reported clinical practice suggests an incidence of haematoma of 1:190,000 epidurals.
@article{wulf_epidural_1996,
	title = {Epidural anaesthesia and spinal haematoma},
	volume = {43},
	issn = {0832-610X},
	doi = {10.1007/BF03013437},
	abstract = {PURPOSE

Haematoma formation in the spinal canal due to epidural anaesthesia is a very rare but serious complication. This paper presents a comprehensive review of case reports.


SOURCE

Sampling of case reports over a 10 yr period, medline-research (1966-1995) and cross-check with former reviews.


FINDINGS

Fifty-one confirmed spinal haematomas associated with epidural anaesthesia were found. Most were related to the insertion of a catheter, a procedure that was graded as difficult or traumatic in 21 patients. Other risk factors were: fibrinolytic therapy (n = 2), previously unknown spinal pathology (n = 2), low molecular weight heparin (n = 2), aspirin or other NSAID (n = 3), epidural catheter inserted during general anaesthesia (n = 3), thrombocytopenia (n = 5), ankylosing spondylitis (n = 5), preexisting coagulopathy (n = 14), and intravenous heparin therapy (n = 18).


CONCLUSION

Coagulopathies or anticoagulant therapy (e.g., full heparinization) were the predominant risk factors, where-as low-dose heparin thromboprophylaxis or NSAID treatment was rarely associated with spinal bleeding complications. Ankylosing spondylitis was identified as a new, previously unreported risk factor. Analysis of reported clinical practice suggests an incidence of haematoma of 1:190,000 epidurals.},
	number = {12},
	journal = {Canadian journal of anaesthesia = Journal canadien d'anesthésie},
	author = {Wulf, H},
	month = dec,
	year = {1996},
	pmid = {8955979},
	keywords = {Anesthesia, Epidural, Hematoma, Humans, Risk Factors, Spinal Canal, Spondylitis, Ankylosing},
	pages = {1260--1271}
}

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