Bleeding during epidural analgesia: case report

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Abstract

BACKGROUND: Bleeding at the puncture site during neuraxial blocks is a potentially dangerous complication, and its risk is significantly increased in patients receiving antithrombotic therapy.

CLINICAL CASE DESCRIPTION: Patient S. (aged 60 years) was admitted to the department of vascular surgery (Vladivostok). He was diagnosed with Leriche’s syndrome, for which he took 100 mg of aspirin and 75 mg of clopidogrel. On January 12, 2022, combined spinal-epidural anesthesia was performed, and the epidural space was punctured on the fourth attempt. However, massive bleeding was observed from the puncture site. Intraoperatively, before the great vessels were clamped, 100 units/kg of heparin (8000 units) was administered. After the operation, the epidural puncture site was revised: the sticker was soaked with hemorrhagic discharge and removed, and a new sticker was applied. On January 12, 2022, nadroparin calcium 9500 IU anti-Xa/ml 0.3 mL was given two times a day in the ICU. On the same day, intensive bleeding was noted in the area where the epidural catheter was located. This was treated locally with cold and two doses of fresh frozen plasma. On January 13, 2022, magnetic resonance imaging of the lumbar spine showed the spinal cord without displacement and compression, the puncture area had no signs of bleeding, the epidural catheter was removed, and the patient was discharged for outpatient treatment on day 7.

CONCLUSION: To reduce bleeding risk in neuraxial blockade, the recommendations for preparing for surgery patients receiving anticoagulant and antiplatelet therapy must be followed, and the pharmacokinetics of antithrombotic drugs must be taken into account. If puncture and catheterization of the epidural space are technically difficult, manipulation should be abandoned.

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About the authors

Alexey Yu. Novikov

Primorsky Regional Clinical Hospital No 1

Author for correspondence.
Email: novikovau@rambler.ru
ORCID iD: 0000-0002-5878-6259
SPIN-code: 8847-1809

MD, Cand. Sci. (Med.), anesthesiologist-resuscitator

Russian Federation, Vladivostok

Grigorii A. Smirnov

Primorsky Regional Clinical Hospital No 1

Email: novikovau@rambler.ru
ORCID iD: 0000-0002-6669-5509
SPIN-code: 5893-6559

MD, Cand. Sci. (Med.), anesthesiologist-resuscitator

Russian Federation, Vladivostok

Oleg A. Titovets

Primorsky Regional Clinical Hospital No 1

Email: novikovau@rambler.ru
ORCID iD: 0000-0001-8585-5988
SPIN-code: 2064-3935

anesthesiologist-resuscitator

Russian Federation, Vladivostok

Viktor A. Koriachkin

Saint-Petersburg State Pediatric Medical University

Email: novikovau@rambler.ru
ORCID iD: 0000-0002-3400-8989
SPIN-code: 6101-0578

MD, Dr. Sci. (Med.), Professor

Russian Federation, Saint-Petersburg

Dmitry V. Zabolotskii

Saint-Petersburg State Pediatric Medical University

Email: novikovau@rambler.ru
ORCID iD: 0000-0002-6127-0798
SPIN-code: 6726-2571

MD, Dr. Sci. (Med.), Professor

Russian Federation, Saint-Petersburg

References

  1. Møller MH, Sigurðsson MI, Olkkola KT, et al. Regional anaesthesia in patients on antithrombotic drugs — a joint ESAIC/ESRA guideline: Endorsement by the Scandinavian Society of Anaesthesiology and Intensive Care Medicine. Acta Anaesthesiol Scand. 2022;66(7):887–889. doi: 10.1111/aas.14093
  2. Horlocker TT, Vandermeuelen E, Kopp SL, et al. Regional Anesthesia in the Patient Receiving Antithrombotic or Thrombolytic Therapy: American Society of Regional Anesthesia and Pain Medicine Evidence-Based Guidelines (Fourth Edition). Reg Anesth Pain Med. 2018;43(3):263–309. doi: 10.1097/AAP.0000000000000763
  3. Pöpping DM, Wenk M. Epidural anesthesia: Clinical application and current developments. Anaesthesiologie. 2022;71(11):893–906. (In German). doi: 10.1007/s00101-022-01209-5
  4. Sites BD, Taenzer AH, Herrick MD, et al. Incidence of local anesthetic systemic toxicity and postoperative neurologic symptoms associated with 12,668 ultrasound-guided nerve blocks: an analysis from a prospective clinical registry. Reg Anesth Pain Med. 2012;37(5):478–482. doi: 10.1097/AAP.0b013e31825cb3d6
  5. Müller-Wirtz LM, Volk T. Big Data in Studying Acute Pain and Regional Anesthesia. J Clin Med. 2021;10(7):1425. doi: 10.3390/jcm10071425
  6. Bos EME, Haumann J, de Quelerij M, et al. Haematoma and abscess after neuraxial anaesthesia: a review of 647 cases. Br J Anaesth. 2018;120(4):693–704. doi: 10.1016/j.bja.2017.11.105
  7. Kaye AD, Manchikanti L, Novitch MB, et al. Responsible, Safe, and Effective Use of Antithrombotics and Anticoagulants in Patients Undergoing Interventional Techniques: American Society of Interventional Pain Physicians (ASIPP) Guidelines. Pain Physician. 2019;22(1S):S75–S128.
  8. Kulikov AV, Shifman EM, Roitman EV, et al. Prevention and treatment of hemorrhagic complications associated with antitrombotic drugs during analgesia in labour and anesthesia in caesarean section. Guidelines. Russian Journal of Anaesthesiology and Reanimatology. 2021;(2):6–18. (In Russ). doi: 10.17116/anaesthesiology20210216
  9. Zabolotskikh IB, Kirov MYu, Afonchikov VS, et al. Perioperative management of patients receiving long-term antithrombotic therapy. Russian Federation of anesthesiologists and reanimatologists guidelines. Alexander Saltanov Intensive Care Herald. 2019;1:7–19. (In Russ). doi: 10.21320/1818-474X-2019-1-7-19
  10. Narouze S, Benzon HT, Provenzano D, et al. Interventional Spine and Pain Procedures in Patients on Antiplatelet and Anticoagulant Medications (Second Edition): Guidelines From the American Society of Regional Anesthesia and Pain Medicine, the European Society of Regional Anaesthesia and Pain Therapy, the American Academy of Pain Medicine, the International Neuromodulation Society, the North American Neuromodulation Society, and the World Institute of Pain. Reg Anesth Pain Med. 2018;43(3):225–262. doi: 10.1097/AAP.0000000000000700
  11. Breivik H, Norum H, Fenger-Eriksen C, et al. Reducing risk of spinal haematoma from spinal and epidural pain procedures. Scand J Pain. 2018;18(2):129–150. doi: 10.1515/sjpain-2018-0041
  12. Kubulus C, Gürtesch CA, Wagenpfeil G, et al. Antithrombotic drugs and the risk of bloody punctures in regional anesthesia — a retrospective registry analysis. Reg Anesth Pain Med. 2022:rapm-2022-103806. doi: 10.1136/rapm-2022-103806
  13. Fernandez S, Lenoir C, Samer CF, Rollason V. Drug-Drug Interactions Leading to Adverse Drug Reactions with Rivaroxaban: A Systematic Review of the Literature and Analysis of VigiBase. J Pers Med. 2021;11(4):250. doi: 10.3390/jpm11040250

Supplementary files

Supplementary Files
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1. Fig. 1. Patient S., 60 years old. Bleeding from the puncture site and catheterization of the epidural space.

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