From the Pain Division, Mayo Clinic Department of Anesthesiology and Perioperative Medicine, Rochester, MN.
Reg Anesth Pain Med. 2018 Apr;43(3):310-312. doi: 10.1097/AAP.0000000000000730.
We present a case report of a patient who developed an epidural hematoma following an interlaminar epidural steroid injection with no risk factors aside from old age and aspirin use for secondary prevention.
A 79-year-old man developed an epidural hematoma requiring surgical treatment following an uncomplicated interlaminar epidural steroid injection performed for neurogenic claudication. In the periprocedural period, he continued aspirin for secondary prophylaxis following a myocardial infarction.
For patients taking aspirin for primary or secondary prophylaxis, the American Society of Regional Anesthesia and Pain Medicine antiplatelet and anticoagulation guidelines for spine and pain procedures recommend a shared assessment and risk stratification when deciding to hold the medication for intermediate-risk neuraxial procedures. Cases such as this serve to highlight the importance of giving careful consideration to medical optimization of a patient even when a low- or intermediate-risk procedure is planned.
我们报告了一例患者在接受经椎间孔硬膜外类固醇注射后发生硬膜外血肿的病例，除了年龄较大和使用阿司匹林进行二级预防外，无其他危险因素。
一名 79 岁男性因神经性跛行接受了一次无并发症的经椎间孔硬膜外类固醇注射后，发生了硬膜外血肿，需要手术治疗。在围手术期，他在心肌梗死后继续使用阿司匹林进行二级预防。
对于因原发性或继发性预防而服用阿司匹林的患者，美国区域麻醉和疼痛医学学会针对脊柱和疼痛操作的抗血小板和抗凝指南建议，在决定是否停止使用药物进行中危性脊神经轴操作时，应进行共同评估和风险分层。此类病例提醒我们，即使计划进行低危或中危手术，也应仔细考虑患者的医疗优化。
