Gustafsson H, Rutberg H, Bengtsson M
Department of Anaesthesia, Central Hospital, Karlstad, Sweden.
Anaesthesia. 1988 Mar;43(3):220-2.
A patient who developed an epidural haematoma with multifactorial aetiology (bleeding diathesis, ankylosing spondylitis, chronic alcoholism and acute pancreatitis) after epidural analgesia for pain relief is described. Our conclusion is that adequate laboratory screening of blood coagulation, including platelet count, should be carried out in this category of patient before attempted epidural blockade, the risks of which must be weighed against the benefits. The block should be allowed to wear off intermittently and repeated neurological assessment performed if an epidural catheter is used for repeated injections or for a continuous infusion of local anaesthetic. Neuroradiological examination should be carried out promptly if an epidural haematoma is suspected and surgical decompression performed without delay if the diagnosis is confirmed.
本文描述了一名患者，其在接受硬膜外镇痛以缓解疼痛后，发生了具有多因素病因（出血素质、强直性脊柱炎、慢性酒精中毒和急性胰腺炎）的硬膜外血肿。我们的结论是，对于此类患者，在尝试进行硬膜外阻滞之前，应进行包括血小板计数在内的充分的实验室凝血筛查，必须权衡其风险与益处。如果使用硬膜外导管进行重复注射或持续输注局部麻醉药，应间歇性地让阻滞消退，并进行重复的神经学评估。如果怀疑有硬膜外血肿，应立即进行神经放射学检查，一旦确诊，应立即进行手术减压。
