[Neuraxial hematoma after combined regional anesthesia: conservative resolution]. / Hematoma neuroaxial tras anestesia locorregional combinada resuelto de forma conservadora.

Epidural hematoma is a rare but serious neurological complication of neuraxial anesthesia. We report the case of a woman in whom this complication presented after knee replacement surgery under combined neuraxial anesthesia. No adverse events occurred during surgery. In the early postoperative period thromboembolic prophylaxis and continuous perfusion of ropivacaine were started through the epidural catheter. Lumbar pain along with sensorimotor alterations in the lower limbs developed on the first day after surgery. Epidural hematoma was suspected and the perfusion of local anesthetic was suspended. A computed tomography scan confirmed the presence of a hematoma with poorly defined margins. The patient was transferred to another hospital for dorsolumbar magnetic resonance, which revealed an extensive hematoma. Surgery was ruled out in favor of conservative treatment. Neurological symptoms resolved slowly over the following days and the patient was discharged partially recovered 51 days after surgery and recovery was complete within 6 postoperative months. We discuss the prevalence, etiology, and treatment of neuraxial hematoma related to local or regional anesthesia.

Hematoma neuroaxial tras anestesia locorregional combinada resuelto de forma conservadora / Neuraxial hematoma after combined regional anesthesia: conservative resolution

El hematoma epidural es una complicación neurológica infrecuente pero grave de la anestesia neuroaxial. Presentamos el caso de una mujer que fue intervenida de implante de prótesis de cadera y desarrolló esta complicación. Se realizó una anestesia combinada neuroaxial. La intervención transcurrió sin incidencias. En el postoperatorio se inició profilaxis tromboembólica y perfusión continua de ropivacaína por catéter epidural. El primer día del postoperatorio, apareció dolor lumbar y alteración sensitivomotora en miembros inferiores. Con la sospecha de hematoma epidural, se suspendió perfusión de anestésico local. Se realizó una tomografía computerizada (TC) que confirmó la existencia de un hematoma con límites mal definidos. Fue trasladada a centro de referencia para realización de resonancia magnética (RM) dorsolumbar, evidenciando un hematoma extenso. Rechazada para intervención quirúrgica se trató de forma conservadora. La evolución neurológica fue lentamente favorable en los días siguientes, siendo dada de alta a los 51 días de la cirugía con recuperación parcial. A los 6 meses de la intervención la recuperación era completa. Se comentan la prevalencia, la etiología y el tratamiento del hematoma neuroaxial asociado a anestesia locorregional

Epidural hematoma is a rare but serious neurological complication of neuraxial anesthesia. We report the case of a woman in whom this complication presented after hip replacement surgery under combined neuraxial anesthesia. No adverse events occurred during surgery. In the early postoperative period thromboembolic prophylaxis and continuous perfusion of ropivacaine were started through the epidural catheter. Lumbar pain along with sensorimotor alterations in the lower limbs developed on the first day after surgery. Epidural hematoma was suspected and the perfusion of local anesthetic was suspended. A computed tomography scan confirmed the presence of a hematoma with poorly defined margins. The patient was transferred to another hospital for dorsolumbar magnetic resonance, which revealed an extensive hematoma. Surgery was ruled out in favor of conservative treatment. Neurological symptoms resolved slowly over the following days and the patient was discharged partially recovered 51 days after surgery and recovery was complete within 6 postoperative months. We discuss the prevalence, etiology, and treatment of neuraxial hematoma related to local or regional anesthesia