Reactions 1270 - 19 Sep 2009

SBupivacaine/heparin

Epidural haematoma in an elderly patient?: casereport

A 78-year-old woman developed an epidural haematomaduring endovascular aortic aneurysm repair (EVAR)including epidural anaesthesia with bupivacaine andinjection of heparin [time to reaction onset not stated].

The woman had a history of hypertension and aninfrarenally located abdominal aortic aneurysm extendingfrom L4 to L5. She underwent EVAR. A needle was insertedat the L3-L4 space and the epidural space was identified. Anepidural bolus of 20mL of 0.25% bupivacaine wasadministered; 10mL of 0.25% bupivacaine was repeated2.5 hours later. IV heparin 5000U was administered1.5 hours after epidural placement [therapeutic indicationnot stated]. Four hours after this heparin dose, the epiduralcatheter was removed. Her recovery from epiduralanaesthesia was prolonged; her legs were still numb andshe was unable to move them, 8 hours after the lastepidural injection. MRI revealed an epidural blood mass,which extended for T12 to L1 and compressed part of themedulla spinalis.

The woman underwent a decompressive laminectomy.Subsequent MRI showed no haematoma and no pressureon the spinal cord; however, her neurological conditionshowed no change. At last follow-up, 2 months later, sheremained paraplegic.

Author comment: "[T]he use of anticoagulants mayincrease the risk of neuraxial block-related epiduralhematoma. . . A case of an epidural hematoma related toepidural anesthesia in an elderly woman who underwentendovascular aortic aneurysm repair (EVAR) is reported."Zeyneloglu P, et al. An epidural hematoma after epidural anesthesia forendovascular aortic aneurysm repair. Journal of Cardiothoracic and VascularAnesthesia 23: 580-582, No. 4, Aug 2009 - Turkey 801150610

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Reactions 19 Sep 2009 No. 12700114-9954/10/1270-0001/$14.95 © 2010 Adis Data Information BV. All rights reserved