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24 Anterior cervical epidural hematoma after combined spinal epidural anesthesia: a case report
  1. SK Coşarcan,
  2. AT Doğan,
  3. D Akbay and
  4. Ö Erçelen
  1. VKV American Hospital, Istanbul, Turkey


Background and Aims The choice of anesthetic technique should be based on the maternal and fetal condition, comorbidities, the expected duration and difficulty of the procedure, and the presence or absence of an in-situ epidural or spinal catheter. Venous thromboembolism (VTE) remains an important cause of morbidity and mortality in the obstetric population. This article presents a case about cervical anterior epidural bleeding and conservative management seen after cesarean with combined spinal-epidural anesthesia.

Methods A 32-year-old woman was admitted to our clinic for a cesarean operation for 36 weeks twin pregnancy. A combined spinal-epidural was planned for the cesarean operation anesthesia. After the operation, the patient with no complaints was transferred to the inpatient clinic by adjusting the epidural patient-controlled analgesia device (PCA) doses.

Results She had a headache in the posterior region of the head that spreads neck and shoulders started 48 hours after the operation. The next day patient was pain-free with analgesic medications and has discharged with low molecular weight heparin prophylaxis. On the postoperative 6th day, neck and shoulder pain were worsened unless she took any anti-inflammatory drug. In the cervical and thoracic MRI, there was a hematoma was detected. Intravenous hydration and anti-inflammatory therapy were organized. The neck and shoulder pain on the second day of his second admission decreased dramatically.

Conclusions The most important thing to mention is that PDDH can mask the hematoma-induced headache. It should be kept in mind that a spinal hematoma can be observed even VTE prophylaxis was started according to guidelines.

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