Neuraxial hematoma after epidural anesthesia. Is it possible to prevent or detect it? Report of two cases.
Spinal hematomas are rare and they affect the central nervous system. They can cause permanent neurologic sequelae and death if they are not treated properly. Early diagnosis and treatment are fundamental for a good neurologic prognostic. The objective of this report was to emphasize for anesthesiologists the importance of early diagnosis and treatment of spinal hematomas, besides improving their prevention. Case 1: The patient underwent epidural lumbar anesthesia for femoropopliteal revascularization. He was being treated with acetylsalicylic acid, clopidogrel, and enoxaparin, which were discontinued before the surgery. The patient developed paraplegia in the immediate postoperative period. Neurosurgical decompression was performed after the diagnosis, but without recovery in the long run. Case 2: The patient underwent epidural lumbar anesthesia for right knee osteotomy, without intercurrences. The patient remained without neurological complaints until approximately 48 hours after the surgery when he developed urinary retention, pain in the right lower limb, paresthesias, and difficulty moving both feet. The MRI showed an epidural lumbar hematoma, and the patient underwent immediate surgical decompression. He showed complete neurological recovery after 10 months of rehabilitation. The clinical cases presented here showed different outcomes, indicating the importance of early diagnosis and treatment for a good evolution. Diagnosis by MRI with early decompression shortly after the development of the first clinical manifestations remains the standard treatment. Identification of patients at risk for neuraxial bleeding and change in anesthetic technique, as well as the establishment of postoperative neurologic evaluation protocols in patients undergoing neuraxial anesthesia can contribute for prevention of severe neurologic sequelae.