Incidence of spinal haematoma after epidural puncture: analysis from the German network for safety in regional anaesthesia

Abstract

Context: The incidence of epidural haematoma after epidural anaesthesia is uncertain.

Objective: To quantify epidural haematoma after epidural anaesthesia in 2008 and 2009 in a network for safety in regional anaesthesia in Germany.

Design: Analysis of data systematically documented within the German network for safety in regional anaesthesia.

Setting: A regional anaesthesia register for clinics recording their clinical practice was set up according to a consented protocol. After checking the registry for the presence of epidural haematoma, all participating centres were asked for the number of epidural haematoma and the number of neuraxial procedures performed during the 2 years. Patient-specific information regarding procedures and outcome were requested.

Main outcome measures: The incidence of epidural haematoma in the network with comorbidities, coagulation status and time from first symptoms, also the performance of MRI and laminectomy.

Results: During a period of 2 years, 33,142 non-obstetric epidural blocks were performed. Five thoracic epidural and one cranial haematoma occurred.

Discussion: The incidence of spinal haematoma was 1: 6 628 in this general surgical population. When local anaesthetics are continuously applied, progressive motor block should increase the level of suspicion. When accompanied by pain or paraesthesia, progression to diagnosis by MRI is mandatory.