Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1590/S0034-70942007000200008
Brazilian Journal of Anesthesiology
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

Referencias

Usubiaga JE. Neurological complications following epidural anesthesia. Int Anesthesiol Clin. 1975;13:39-45.

Krombach JW, Dagtekin O, Kampe S. Regional anesthesia and coagulation. Curr Opin Anaesthesiol. 2004;17:427-433.

Vandermeulen EP, Van Aken H, Vermylen J. Anticoagulants and spinal-epidural anesthesia. Anesth Analg. 1994;79:1165-1177.

Gogarten W, Van Aken H, Büttner J. Regional anesthesia and thromboembolism prophylaxis/anticoagulation. Revised guidelines of the German Society of Anaesthesiology and Intensive Care Medicine. Anaesthesiol Intensivmed. 2003;44:218-230.

Horlocker TT, Wedel DJ, Benzon H. Regional anesthesia in the anticoagulated patient: defining the risks. Reg Anesth Pain Med. 2003;28:172-197.

Schroeder DR. Statistics: Detecting a rare adverse drug reaction using spontaneous reports. Reg Anesth Pain Med. 1998;23:183-189.

Modig J, Borg T, Karlstrom G. Thromboembolism after total hip replacement: role of epidural and general anesthesia. Anesth Analg. 1983;62:174180.

Yeager M, Glass D, Neff R. Epidural anesthesia and analgesia in high-risk surgical patients. Anesthesiology. 1987;66:723724.

Tryba M. Epidural regional anesthesia and low molecular heparin: pro. Anaesthesiol Intensivmed Notfallmed Schmerzther. 1993;28:179181.

Fox J. Spinal and epidural anesthesia and anticoagulation. Int Anesthesiol Clin. 2001;39:51-61.

Owens E, Kasten G, Hessel E. Spinal subarachnoid hematoma after lumbar puncture and heparinization: a case report, review of the literature, and discussion of anesthetic implications. Anesth Analg. 1986;65:12011207.

Ayerbe J, Quinones D, Prieto E. Spinal subarachnoid hematoma after lumbar puncture in a patient with leukemia: report of a case and review of the literature. Neurocirugia. 2005;16:447-452.

Domenicucci M, Ramieri A, Paolini S. Spinal subarachnoid hematomas: our experience and literature review. Acta Neurochir. 2005;147:741-750.

Castillo J, Santiveri X, Escolano F. Spinal cord compression caused by hematoma related to a neuroaxial anesthesia in Spain. Rev Esp Anestesiol Reanim. 2003;50:504-509.

Chan L, Bailin MT. Spinal epidural hematoma following central neuraxial blockade and subcutaneous enoxaparin: a case report. J Clin Anesth. 2004;16:382-385.

Foo D, Rossier AB. Preoperative neurological status in predicting surgical outcome of spinal epidural hematoma. Surg Neurol. 1981;15:389-401.

Onishchuk JL, Carlsson C. Epidural hematoma associated with epidural anesthesia: Complications of anticoagulant therapy. Anesthesiology. 1992;77:1221-1223.

Inoue K, Yokoyama M, Nakatsuka H. Spontaneous resolution of epidural hematoma after continuos epidural analgesia in a patient without bleeding tendency. Anesthesiology. 2002;97:735-737.

Boukobza M, Guichard JP, Boissonet M. Spinal epidural hematoma: report of 11 cases and review of literature. Neuroradiology. 1994;36:456-459.

Wagner S, Forsting M, Hache W. . .

Morisaki H, Doi J, Ochiai R. Epidural hematoma after epidural anesthesia in a patient with hepatic cirrhosis. Anesth Analg. 1995;80:1033-1035.

Lawton MT, Porter RW, Heiserman JE. Surgical management of spinal epidural hematoma: relationship between surgical timing and neurological outcome. J Neurosurg. 1995;83:1-7.

Wulf H. Epidural anaesthesia and spinal haematoma. Can J Anaesth. 1996;43:1260-1271.

Robins K, Saravanan S, Watkins E. Ankylosing spondylitis and epidural haematoma. Anaesthesia. 2005;60:624-625.

La Rosa G, Conti A. Magnetic resonance imaging-monitored conservative management of traumatic spinal epidural hematomas. J Neurosurg. 1999;91:128-132.

Duffilll J, Sparrow OC, Millar J. Can spontaneous spinal epidural hematoma be managed safely without operation?: A report of four cases. J Neurol Neurosurg Psychiatry. 2000;69:816-819.

Bromage PR. Neurological complications of subarachnoid and epidural anaesthesia. Acta Anesthesiol Scand. 1997;41:439-444.

De Tommaso O, Caporuscio A, Tagariello V. Neurological complications following central neuraxial blocks: are there predictive factors?. Eur J Anesthesiol. 2002;19:705-716.

Auroy Y, Narchi P, Messiah A. Serious complications related to regional anesthesia: results of a prospective survey in France. Anesthesiology. 1997;87:479-486.

Yoshii WY, Rottman RL, Rosenblatt RM. Epidural catheter induced traumatic radiculopathy in obstetrics: one centre's experience. Reg Anesth. 1994;19:132-135.

Horlocker TT, McGregor DG, Matsushige DK. A retrospective review of 4767 consecutive spinal anesthetics: central nervous system complications. Perioperative Outcomes Group. Anesth Analg. 1997;84:578-584.

Knowles PR, Randall NP, Lockhart AS. Vascular trauma associated with routine spinal anaesthesia. Anaesthesia. 1999;54:647-650.

Reynolds F. Damage to the conus medullaris following spinal anaesthesia. Anaesthesia. 2001;56:238-247.

Van Gessel EF, Forster A, Gamulin Z. Continuous spinal anesthesia: where do spinal catheters go?. Anesth Analg. 1993;76:1004-1007.

Broadbent CR, Maxwell WB, Ferrie R. Ability of anaesthetists to identify a marked lumbar interspace. Anaesthesia. 2000;55:1106-1126.

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