Department of Anesthesiology, The Affiliated Guangdong Second Provincial General Hospital of Jinan University, No. 466, Shi liugang road, Hai zhu District, Guangzhou, Guangdong Province, China.
Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China.
BMC Anesthesiol. 2024 Jul 12;24(1):235. doi: 10.1186/s12871-024-02619-1.
Delayed spinal epidural hematoma (SEH) following central neuraxial block (CNB) is a rare but serious complication. The underlying causes of SEH associated with neuraxial anesthesia are still unclear. Furthermore, the decision between surgical intervention and conservative management for SEH remains a complex and unresolved issue.
We report a case of delayed SEH in a 73-year-old woman who underwent vaginal hysterectomy under combined spinal-epidural anesthesia, with the administration of postoperative anticoagulants to prevent deep vein thrombosis on the 1st postoperative day (POD). She experienced symptoms 56 h after CNB. Magnetic resonance imaging (MRI) revealed a dorsal SEH at the L1-L4 level with compression of the thecal sac. On conservative treatment, full recovery was achieved after six months.
This case reminds anesthesiologists should be alert to the possible occurrence of a delayed SEH following CNB, particularly with the administration of anticoagulants. Immediate neurological evaluation of neurological deficit and MRI are advised. Conservative treatment combined with close and dynamic neurological function monitoring may be feasible for patients with mild or nonprogressive symptoms even spontaneous recovery.
椎管内麻醉（CNB）后延迟性硬脊膜外血肿（SEH）是一种罕见但严重的并发症。与椎管内麻醉相关的 SEH 的潜在原因仍不清楚。此外，对于 SEH 是否进行手术干预和保守治疗的决策仍然是一个复杂且未解决的问题。
我们报告了一例 73 岁女性患者的延迟性 SEH 病例，该患者在联合脊髓-硬膜外麻醉下行阴道子宫切除术，并在术后第 1 天（POD）给予抗凝药物以预防深静脉血栓形成。她在 CNB 后 56 小时出现症状。磁共振成像（MRI）显示 L1-L4 水平的背侧 SEH，伴有硬脊膜囊受压。在保守治疗下，患者在 6 个月后完全康复。
该病例提醒麻醉医生应警惕 CNB 后可能发生延迟性 SEH，特别是在使用抗凝药物的情况下。建议立即进行神经功能评估和 MRI。对于症状轻微或无进展或甚至自发性恢复的患者，保守治疗联合密切和动态的神经功能监测可能是可行的。
