Hematoma após raquianestesia tratado conservadoramente: relato de caso e revisão da literatura

Daniel Segabinazzi; Betina Comiran Brescianini; Felipe Gornicki Schneider; Florentino Fernandes Mendes

doi:10.1590/S0034-70942007000200008

Clinical Information

Hematoma após raquianestesia tratado conservadoramente: relato de caso e revisão da literatura

Conservative treatment of hematoma after spinal anesthesia: case report and literature review

Daniel Segabinazzi; Betina Comiran Brescianini; Felipe Gornicki Schneider; Florentino Fernandes Mendes

http://dx.doi.org/10.1590/S0034-70942007000200008 Braz J Anesthesiol, vol.57, n2, p.188-194, 2007

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Resumo

JUSTIFICATIVA E OBJETIVOS: Durante a realização de anestesia espinal existe o risco de ocorrer sangramentos. A compressão do tecido nervoso, secundária à formação de hematoma, pode determinar o surgimento de lesão neurológica que se não for diagnosticada e tratada a tempo pode ser permanente. A identificação dos fatores de risco, o diagnóstico e o tratamento precoce da compressão são importantes para o prognóstico do paciente. O objetivo deste trabalho foi descrever um caso de hematoma após raquianestesia tratado de forma conservadora e revisar os trabalhos na literatura. RELATO DO CASO: Paciente do sexo masculino, 73 anos, 65 kg, 1,67 m, estado físico ASA III. Foi submetido a raquianestesia para retirada de cateter de diálise peritoneal. Durante a realização da punção ocorreram parestesias no membro inferior direito. Foram injetados 15 mg de bupivacaína hiperbárica a 0,5% sem vasoconstritor. Vinte e quatro horas após a realização do bloqueio o paciente permanecia com anestesia em sela e com dor lombar, e 48 horas após o procedimento apresentou incontinência urinária. A ressonância nuclear magnética demonstrou existência de processo expansivo subaracnóideo, com compressão de raízes nervosas (L4 a S1). Após avaliação do neurocirurgião, instituiu-se tratamento conservador. O paciente recebeu alta hospitalar no 18° dia de pós-operatório, assintomático. CONCLUSÕES: O caso apresentado mostrou boa evolução com o tratamento conservador.

Palavras-chave

COMPLICAÇÕES, TÉCNICA ANESTÉSICA, Regional

Abstract

BACKGROUND AND OBJECTIVES: Spinal anesthesia caries the risk of bleeding. Compression of nervous tissue secondary to the formation of a hematoma can cause neurological damage, which, if not diagnosed and treated in a timely fashion, can be permanent. The identification of risk factors, diagnosis, and early treatment are important for the prognosis. The objective of this report was to describe the case of a hematoma after spinal anesthesia treated conservatively, and review the literature. CASE REPORT: Male patient, 73 years old, 65 kg, 1.67 m, and ASA physical status III, underwent spinal anesthesia for removal of a peritoneal dialysis catheter. During the puncture, the patient experienced paresthesia of the right lower limb. Fifteen milligrams of 0.5% hyperbaric bupivacaine without vasoconstrictor were administered. Twenty-four hours later, saddle anesthesia and lumbar pain persisted and, after 48 hours, the patient presented urinary incontinence. An MRI demonstrated the presence of an expansive subarachnoid process compressing the nerve roots (L4 and S1). After evaluation by the neurosurgeon, conservative treatment was instituted. The patient was discharged from the hospital on the 18th postoperative day, asymptomatic. CONCLUSIONS: The case reported here presented a good evolution with the conservative treatment.

Keywords

ANESTHETIC TECHNIQUES, Regional, COMPLICATIONS

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Hematoma após raquianestesia tratado conservadoramente: relato de caso e revisão da literatura

Conservative treatment of hematoma after spinal anesthesia: case report and literature review

Daniel Segabinazzi; Betina Comiran Brescianini; Felipe Gornicki Schneider; Florentino Fernandes Mendes

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