title: Extradural abscess complicating extradural anaesthesia for caesarean section.
abstract: Extradural abscess has been described infrequently as a complication of extradural anaesthesia and analgesia. We describe an abscess that developed 5 days after operation in a patient who had extradural anaesthesia for Caesarean section and postoperative analgesia, and review the literature on extradural abscess complicating extradural catheterization, including a discussion on pathogenesis, clinical presentation, diagnosis and management. There have now been 16 reported cases of extradural catheter-related extradural abscess. Only one previous case has been in obstetric practice, despite the widespread use of these techniques in this specialty. A disproportionate number of cases have involved thoracic catheters. Duration of catheterization ranged from 40 h to 6 weeks, the majority of catheters being in place for 5 days or less. The time from catheter placement to development of symptoms ranged from 72 h to 5 months. The causative organism was isolated in 11 cases: Staphylococcus aureus was identified in nine (82%) and Staphylococcus epidermidis in two (18%). Outcome was reported in 15 cases, of which seven (47%) had a full or near full recovery and eight (53%) had a persistent neurological deficit. One case was managed successfully without surgery. Fifty percent of all cases have been reported in the past 5 years. With the increasing use of extradural techniques for anaesthesia and analgesia, this serious complication may be seen more frequently in the future.
authors: Department of Surgery, Wellington School of Medicine, New Zealand.
authors: W D
authors: WD
authors: Ngan Kee
authors: M R
authors: MR
authors: Jones
authors: P
authors: P
authors: Thomas
authors: R J
authors: RJ
authors: Worth
mesh_terms: D000038:Abscess / Q000209:etiology*; D000328:Adult; D000767:Anesthesia, Epidural / Q000009:adverse effects*; D000773:Anesthesia, Obstetrical / Q000009:adverse effects*; D002585:Cesarean Section; D004824:Epidural Space; D005260:Female; D006801:Humans; D011183:Postoperative Complications; D011247:Pregnancy; D013203:Staphylococcal Infections