title: Epidural anaesthesia and spinal haematoma.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  Sampling of case reports over a 10 yr period, medline-research (1966-1995) and cross-check with former reviews.
  
  
  RESULTS
  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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Anaesthesiology and Intensive Care Medicine, Hospital of the Christian-Albrechts-University of Kiel, Germany. H.WULF@ANAESTHESIE.UNI-KIEL.DE
authors.forename: H
authors.initials: H
authors.lastname: Wulf
mesh_terms: D000767:Anesthesia, Epidural / Q000009:adverse effects*; D006406:Hematoma / Q000209:etiology*; D006801:Humans; D012307:Risk Factors; D013115:Spinal Canal; D013167:Spondylitis, Ankylosing / Q000150:complications