Background and Aims Neuraxial techniques are highly-effective to improve multimodal analgesia. Serious complications are rare, more common with epidural, particularly epidural hematoma(EH) and coagulopathy1. Complication rates after failed neuraxial techniques are less known.
Methods 78-years-old woman submitted to open Whipple procedure with atrial fibrillation on warfarin. 5 days before surgery warfarin was discontinued and replaced by enoxaparin. Adequate stopping time of anticoagulation and normal coagulation and platelet were assured. Before GA,D11-D12 epidural catheter placement(ECP) was attempted by a senior anaesthesiologist, 3times without success. ECP was cancelled. No complications nor patient complaints. Patient was not referred to the acute pain unit(APU). Hospital Discharge(HD) home at 7thpostoperative day without neurologic symptoms. Enoxaparin anticoagulation started 6 hours after surgery. Warfarin initiation was scheduled.
Results 3 days after HD, patient went to emergency department with fever and abdominal pain. CT-scan revealed peritonitis and EH at the posterior portion vertebral canal, D12-L1 level, with spinal-cord compression. No neurologic symptoms. APU and neurosurgery evaluation requested. MRI confirmed EH diagnosis. Anticoagulation was stopped. Spinal compression signs were monitored. 5 days after, follow-up MRI revealed a EH size-reduction and no spinal-cord compression. Patient never reported neurologic symptoms. HD after 12 days with favorable neurologic progress. No neurologic deficits were reported. MRI showed complete resolution of EH.
Conclusions Clinical suspicion, particularly on anticoagulated patients, and careful monitorization since EH diagnosis is mandatory. Even with adequate anticoagulation drugs stopping time, normal coagulation function, EH may appear. In few asymptomatic patients close monitoring and MRI-scanning is enough. Surgical intervention may be necessary in the absence of symptomatic recovery or haematoma resolution.
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