VanderWielen Beth, Rubenstein Lindsay, Shnider Marc, Ku Cindy, Wakakuwa Jason
From the Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts.
A A Case Rep. 2017 Jun 1;8(11):294-296. doi: 10.1213/XAA.0000000000000492.
A 71-year-old woman on aspirin presented for a distal pancreatectomy, splenectomy, and partial colectomy with a T8/9 epidural catheter placed preoperatively in 3 attempts. Prophylactic 5000 units of subcutaneous heparin were given before the procedure. After catheter removal on postoperative day 2, the patient developed transient bilateral lower extremity paralysis, with near complete recovery within 30 minutes. An urgent MRI revealed a T4-T8 epidural hematoma prompting an emergent T3-T8 laminectomy. This case presentation highlights the need for heightened awareness regarding complications related to neuraxial analgesia in patients receiving unfractionated heparin for thromboembolism prophylaxis with concurrent aspirin use.
一名71岁服用阿司匹林的女性因行胰体尾切除术、脾切除术和部分结肠切除术入院，术前放置T8/9硬膜外导管时尝试了3次。术前给予5000单位皮下肝素进行预防。术后第2天拔除导管后，患者出现短暂性双侧下肢麻痹，30分钟内几乎完全恢复。紧急MRI显示T4 - T8硬膜外血肿，促使紧急行T3 - T8椎板切除术。本病例报告强调，对于接受普通肝素预防血栓栓塞并同时使用阿司匹林的患者，需要提高对与椎管内镇痛相关并发症的认识。
