Blasi A, Fita G, Gomar C, Adalia R, Jiménez M J
Servicio de Anestesiología, Hospital Clínic i Provincial, Barcelona.
Rev Esp Anestesiol Reanim. 1998 Aug-Sep;45(7):294-7.
Epidural hematoma is a rare but serious neurological complication of epidural anesthesia. We report the case of a 61-year-old man with squamous cell carcinoma of the lung who suffered an epidural hematoma after undergoing right double lobectomy. Before anesthetic induction an epidural catheter was inserted to the D5-D6 space for postoperative analgesia. Surgery was without noteworthy events and the patient was extubated in the operating room; 5,000 IU of low molecular weight heparin was injected subcutaneously every 24 hours and 5 mg of methadone was provided by epidural catheter every 8 hours. After removal of the catheter three days after surgery, lumbar back pain and hypoesthesia, and weakness in both legs appeared. Epidural hematoma was suspected and treatment with 30 mg.kg-1 of methylprednisolone i.v. was started. Nuclear magnetic resonance imaging of the lumbar spine confirmed the presence of a hematoma at D6-D8. Neurologic symptoms improved in the following hours and additional surgery was not required. The patient was released without neurological symptoms 10 days after lung surgery. We discuss the prevalence, etiology and treatment of epidural hematoma related to epidural anesthesia.
硬膜外血肿是硬膜外麻醉一种罕见但严重的神经并发症。我们报告一例61岁男性肺鳞状细胞癌患者，在接受右肺双叶切除术后发生硬膜外血肿。麻醉诱导前，在D5-D6间隙置入硬膜外导管用于术后镇痛。手术过程顺利，患者在手术室拔管；每24小时皮下注射5000 IU低分子肝素，每8小时通过硬膜外导管给予5 mg美沙酮。术后三天拔除导管后，患者出现腰背痛、感觉减退及双下肢无力。怀疑为硬膜外血肿，开始静脉注射30 mg·kg-1甲泼尼龙进行治疗。腰椎核磁共振成像证实D6-D8存在血肿。数小时后神经症状改善，无需进一步手术。肺手术后10天，患者出院时无神经症状。我们讨论了与硬膜外麻醉相关的硬膜外血肿的发生率、病因及治疗。
