Epidural anaesthesia and spinal haematoma

Purpose: Haematoma formation in the spinal canal due to epidural anaesthesia is a very rare but serious complication. This paper presents a comprehensive review of case reports. Source: Sampling of case reports over a 10 yr period, medline(R)-research (1966-1995) and cross-check with former reviews. Findings: Fifty-one confirmed spinal haematomas associated with epidural anaesthesia were found. Most were related to the insertion of a catheter, a procedure that was graded as difficult or traumatic in 21 patients. Other risk factors were. fibrinolytic therapy (n = 2), previously unknown spinal pathology (n = 2), low molecular weight heparin (n = 2), aspirin or other NSAID (n = 3), epidural catheter inserted during general anaesthesia (n = 3), thrombocytopenia (n = 5), ankylosing spondylitis (n = 5), preexisting coagulopathy (n = 14), and intravenous heparin therapy (n = 18). Conclusion: Coagulopathies or anticoagulant therapy (e.g., full heparinization) were the predominant risk factors, whereas low-dose heparin thromboprophylaxis or NSAID treatment was rarely associated with spinal bleeding complications. Ankylosing spondylitis was identified as a new, previously unreported risk factor Analysis of reported clinical practice suggests an incidence of haematoma of 1:190,000 epidurals.