Thromboprophylaxis and neuraxial anesthesia.
Spinal hematoma is a rare and potentially catastrophic complication of spinal or epidural anesthesia. Risk factors include traumatic needle/catheter placement, sustained anticoagulation in an indwelling neuraxial catheter, and catheter removal during therapeutic levels of anticoagulation. Generally, a patient's coagulation status should be optimized at the time of spinal or epidural needle/catheter placement, and the level of anticoagulation should be monitored during epidural catheterization. Signs of cord compression, such as severe back pain, progression of numbness or weakness, and bowel and bladder dysfunction, warrant immediate radiographic evaluation. A delay in diagnosis and intervention of spinal hematoma may lead to irreversible cord ischemia.
Horlocker
Terese T
TT
Department of Anesthesiology, Mayo Clinic, Rochester, Minn, USA.
D000767:Anesthesia, Epidural / Q000009:adverse effects*; D000775:Anesthesia, Spinal / Q000009:adverse effects*; D001182:Arthroscopy / Q000009:adverse effects; D005343:Fibrinolytic Agents / Q000009:adverse effects* / Q000627:therapeutic use*; D006407:Hematoma, Epidural, Cranial / Q000209:etiology*; D006408:Hematoma, Subdural / Q000209:etiology*; D006495:Heparin, Low-Molecular-Weight / Q000009:adverse effects* / Q000627:therapeutic use*; D006801:Humans; D013927:Thrombosis / Q000209:etiology / Q000517:prevention & control*; D013997:Time Factors
D005343:Fibrinolytic Agents; D006495:Heparin, Low-Molecular-Weight