title: [Neuraxial hematoma after combined regional anesthesia: conservative resolution].
abstract: Epidural hematoma is a rare but serious neurological complication of neuraxial anesthesia. We report the case of a woman in whom this complication presented after knee replacement surgery under combined neuraxial anesthesia. No adverse events occurred during surgery. In the early postoperative period thromboembolic prophylaxis and continuous perfusion of ropivacaine were started through the epidural catheter. Lumbar pain along with sensorimotor alterations in the lower limbs developed on the first day after surgery. Epidural hematoma was suspected and the perfusion of local anesthetic was suspended. A computed tomography scan confirmed the presence of a hematoma with poorly defined margins. The patient was transferred to another hospital for dorsolumbar magnetic resonance, which revealed an extensive hematoma. Surgery was ruled out in favor of conservative treatment. Neurological symptoms resolved slowly over the following days and the patient was discharged partially recovered 51 days after surgery and recovery was complete within 6 postoperative months. We discuss the prevalence, etiology, and treatment of neuraxial hematoma related to local or regional anesthesia.
authors.affiliation: Servicio de Anestesiología y Reanimación, Hospital Central de la Cruz Roja "San José y Santa Adela" Madrid. smalcrudo@telefonica.net
authors.forename: S
authors.initials: S
authors.lastname: Martín
authors.forename: A
authors.initials: A
authors.lastname: Smaranda
authors.forename: J
authors.initials: J
authors.lastname: Archilla
authors.forename: J
authors.initials: J
authors.lastname: Gómez de Orellana
authors.forename: F
authors.initials: F
authors.lastname: Ramasco
authors.forename: B
authors.initials: B
authors.lastname: Muñoz
authors.forename: A
authors.initials: A
authors.lastname: Colmenero
authors.forename: F
authors.initials: F
authors.lastname: Simón
authors.forename: A
authors.initials: A
authors.lastname: Tabatabaian
mesh_terms: D000368:Aged; D000577:Amides; D015360:Analgesia, Epidural; D000767:Anesthesia, Epidural; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D000925:Anticoagulants / Q000009:adverse effects*; D019645:Arthroplasty, Replacement, Knee; D001416:Back Pain / Q000209:etiology; D002045:Bupivacaine; D003907:Dexamethasone / Q000627:therapeutic use; D004630:Emergencies; D017984:Enoxaparin / Q000009:adverse effects*; D005242:Fecal Incontinence / Q000209:etiology*; D005260:Female; D005283:Fentanyl; D046748:Hematoma, Epidural, Spinal / Q000139:chemically induced / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000209:etiology*; D046649:Hematoma, Subdural, Spinal / Q000139:chemically induced / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000209:etiology*; D006429:Hemiplegia / Q000209:etiology*; D006801:Humans; D008279:Magnetic Resonance Imaging; D011183:Postoperative Complications / Q000209:etiology* / Q000517:prevention & control; D011595:Psychomotor Agitation / Q000209:etiology*; D011677:Punctures / Q000009:adverse effects*; D000077212:Ropivacaine; D013346:Subarachnoid Space; D013927:Thrombosis / Q000517:prevention & control; D014057:Tomography, X-Ray Computed; D014549:Urinary Incontinence / Q000209:etiology*
chemical_list: D000577:Amides; D000893:Anti-Inflammatory Agents; D000925:Anticoagulants; D017984:Enoxaparin; D000077212:Ropivacaine; D003907:Dexamethasone; D005283:Fentanyl; D002045:Bupivacaine