What would be the clinical signs of epidural hematoma in a patient who is receiving an infusion of local anesthetic or opioid through an epidural catheter?
Spinal hematomas following neuraxial blockade can occur in both the subdural and epidural spaces8. The first symptom of spinal hematoma is typically the sudden onset of severe back pain. This is followed by radicular signs such as numbness, paresthesias, motor weakness, and loss of deep-tendon reflexes. Neurologic signs may progress to frank paraparesis, urinary retention and fecal incontinence. The onset of symptoms may be delayed for as long as 96 hours after neuraxial blockade.
The presence of local anesthetics and opioids may mask back pain. Motor and sensory loss may be confused for local anesthetic effect. The presence of a motor and sensory block that is unusually prolonged following the cessation of the local anesthetic infusion may be the only sign of epidural hematoma8. Patients should be informed of the expected duration of the anesthetic and should be instructed to watch for unusual prologation of the block. Continuous and careful neurologic monitoring, including intermittent interruption of a continuous blockade, should be considered for patients at risk4.
REFERENCES
8. Sternlo-J-E, Hybbinette-C-H. Spinal subdural bleeding after attempted epidural and subsequent spinal anaesthesia in a patient on thromboprophylaxis with low molecular weight heparin. [case report] Acta Anaesthesiol Scand. 1995;39:P 557-9.
4. Modig-J. Spinal or epidural anaesthesia with low molecular weight heparin for thromboprophylaxis required careful postoperative neurological observation [editorial]. Acta Anaesthesiol Scand 1992:36;603-4.