Blood and Pus: Hemorrhagic and Infectious Complications

Spinal Hematoma The actual incidence of neurologic dysfunction resulting from hemorrhagic complications associated with neuraxial blockade is unknown; however, the incidence cited in the literature is estimated to be less than 1 in 150,000 epidural and less than 1 in 220,000 spinal anesthetics (Tryba 1993). In a review of the literature between 1906 and 1994, Vandermeulen et al. (Vandermeulen 1994) reported 61 cases of spinal hematoma associated with epidural or spinal anesthesia. In 87% of patients, a hemostatic abnormality or traumatic/difficult needle placement was present. More than one risk factor was present in 20 of 61 cases. Importantly, although only 38% of patients had partial or good neurologic recovery, spinal cord ischemia tended to be reversible in patients who underwent laminectomy within eight hours of onset of neurologic dysfunction.