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SP32 Neuraxial emergencies: diagnosis & management
  1. Paul Kessler
  1. Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital, Frankfurt, Germany


In rare cases, serious complications occur after neuroaxial anaesthesia procedures. The most serious ones are haematoma, or abscess. Bleeding into the spinal canal caused by central neuraxial blocks (CNB), are rare but potentially tragic complications that may result in permanent paraplegia and urinary and/or rectal incontinence.

Timely detection, targeted diagnostics and rapid therapy prevent permanent damage. This requires certain organizational requirements, which include procedural instructions and interdisciplinary agreements on the management of complications.

Knowing the early symptoms is essential. Early detection and treatment of a haematoma in the spinal canal reduce the risk of permanent spinal cord damage The presenting symptoms are a result of spinal cord injury or root dysfunction and include paresis, sensory changes or loss of sensation and sphincter dysfunction (urinary or anal). They require immediate neuroradiological diagnostics, such as magnetic resonance imaging, the imaging modality of choice. The most effective treatment is surgical evacuation of haematoma within less than about 6–8 h of appearance of neurologic symptoms, but longer delays do not justify refraining from surgery. Measures that facilitate early detection and treatment of a haematoma include the use of the lowest possible concentration of local anaesthetic, not to manipulate or remove the epidural catheter when antihaemostatic drugs are still effective, to assess leg weakness and sensory levels every 4–6 h during on-going epidural analgesia and for at least 24 h after removal of an epidural catheter and stopping epidural infusion after the appearance of new neurological symptoms.

An important point is also thorough knowledge of risk factors. The risk factors may be related to antihaemostatic drugs, to patients’ co-morbidities and to the number of puncture attempts.

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