Subdural Hematoma Associated With Labor Epidural Analgesia: A Case Series
| Autor: | Joseph S. DeRenzo, Jamie M. Zorn, Jonathan H. Waters, Grace Lim, Yuanxu J. Dong |
|---|---|
| Rok vydání: | 2016 |
| Předmět: |
Adult
medicine.medical_specialty Time Factors Post-dural-puncture headache Neurologic Signs macromolecular substances Article 03 medical and health sciences Young Adult 0302 clinical medicine Hematoma 030202 anesthesiology Pregnancy Risk Factors medicine Humans Retrospective Studies Labor Pain Decompressive hemicraniectomy Labor Obstetric business.industry Retrospective cohort study General Medicine Labor pain Tertiary care hospital medicine.disease Surgery Analgesia Epidural Epidural catheter Anesthesiology and Pain Medicine Hematoma Subdural Treatment Outcome Female medicine.symptom Post-Dural Puncture Headache business Hospital stay 030217 neurology & neurosurgery |
| Zdroj: | Regional anesthesia and pain medicine. 41(5) |
| ISSN: | 1532-8651 |
| Popis: | Objective This report aimed to describe the characteristics and impact of subdural hematoma (SDH) after labor epidural analgesia. Case reports Eleven obstetric patients had SDHs associated with the use of labor epidural analgesia over 7 years at a tertiary care hospital. Ten of 11 patients had signs consistent with postdural puncture headache before the diagnosis of SDH. Five patients (45%) had a recognized unintentional dural puncture, 1 (9%) had a combined spinal-epidural with a 24-gauge needle, and 5 (45%) had no recognized dural puncture. For 10 of the 11 cases, SDH was diagnosed at a mean of 4.1 days (range, 1-7 days) after performance of labor epidural analgesia; one case was diagnosed at 25 days. Ten (91%) of 11 cases had a second hospital stay for a mean of 2.8 days (range, 2-4 days) for observation, without further requirement for neurosurgical intervention. One case (9%) had decompressive hemicraniectomy after becoming unresponsive. The observed rate of labor epidural analgesia-associated SDH was 0.026% (11 in 42,969, approximately 1:3900), and the rate of SDH was 1.1% (5 in 437, approximately 1:87) if a recognized dural puncture occurred during epidural catheter placement. Conclusions Subdural hematoma after labor epidural anesthesia is rare but potentially more common than historically estimated. Cases of postdural puncture headache after labor epidural anesthesia should be monitored closely for severe neurologic signs and symptoms that could herald SDH. |
| Databáze: | OpenAIRE |
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