Epidural Hematomas After Removal of Percutaneous Spinal Cord Stimulator Trial Leads Two Case Reports

被引:28
作者
Giberson, Curren E. [1 ]
Barbosa, Judith [1 ]
Brooks, Elizabeth S. [1 ]
McGlothlen, Gail L. [2 ]
Grigsby, Eric J. [2 ]
Kohut, James J. [3 ]
Wolbers, Linda L. [1 ]
Poree, Lawrence R. [1 ,4 ]
机构
[1] Pain Clin Monterey Bay, Aptos, CA 95003 USA
[2] Napa Pain Inst, Napa, CA 94558 USA
[3] Palo Alto Med Fdn, Dept Neurosurg, Santa Cruz, CA USA
[4] Univ Calif San Francisco, Dept Anesthesia & Perioperat Care, San Francisco, CA 94143 USA
关键词
LOW-DOSE ASPIRIN; PLATELET-FUNCTION; PROSTAGLANDIN SYNTHETASE; BLEEDING-TIME; BLOOD-LOSS; CYCLOOXYGENASE; INHIBITION; PAIN; COMPLICATIONS; SURGERY;
D O I
10.1097/AAP.0000000000000026
中图分类号
R614 [麻醉学];
学科分类号
100217 ;
摘要
Objective: We report 2 cases of spinal epidural hematoma formation after the removal of percutaneous spinal cord stimulator trial leads and discuss the possible etiologies of these complications. Case Report: Two patients developed spinal epidural hematomas shortly after removal of their percutaneous trial leads and required multi-level laminectomies for evacuation of the hematoma. Patient 1 reported taking aspirin the morning that his leads were pulled, whereas patient 2 had not taken aspirin in the 7 days before commencing his trial. There were 2 days between identification and evacuation of patient 1's hematoma, and he did not fully recover from the injury to his spinal cord. Patient 2 underwent surgery immediately with complete resolution of his symptoms. Conclusions: Currently, the neuromodulation community ascribes to the American Society of Regional Anesthesia and Pain Medicine guidelines, which state that nonsteroidal anti-inflammatory drugs do not significantly increase the risk for epidural hematoma with neuraxial anesthesia and, therefore, there is no need to discontinue these drugs before epidural or spinal anesthesia. We suggest that these guidelines may not be appropriate for neuromodulatory techniques that likely subject the surrounding vasculature to more trauma than neuraxial anesthesia. We recommend discontinuing nonsteroidal anti-inflammatory drugs, particularly aspirin, before neuromodulation procedures. Further investigation will establish a time-frame for holding these drugs to optimize patient safety.
引用
收藏
页码:73 / 77
页数:5
相关论文
共 41 条
[1]   DOSAGE FREQUENCY FOR SUPPRESSION OF PLATELET-FUNCTION BY LOW-DOSE ASPIRIN THERAPY [J].
BRADLOW, BA ;
CHETTY, N .
THROMBOSIS RESEARCH, 1982, 27 (01) :99-110
[2]   INHIBITION OF PLATELET PROSTAGLANDIN SYNTHETASE BY ORAL ASPIRIN [J].
BURCH, JW ;
STANFORD, N ;
MAJERUS, PW .
JOURNAL OF CLINICAL INVESTIGATION, 1978, 61 (02) :314-319
[3]   Safety and efficacy of spinal cord stimulation for the treatment of chronic pain: a 20-year literature review [J].
Cameron, T .
JOURNAL OF NEUROSURGERY, 2004, 100 (03) :254-267
[4]   Anti-platelet drugs: Do they affect megakaryocytes? [J].
Cazenave, JP ;
Gachet, C .
BAILLIERES CLINICAL HAEMATOLOGY, 1997, 10 (01) :163-180
[5]  
DECATERINA R, 1992, THROMB HAEMOSTASIS, V67, P258
[6]   Polyanalgesic Consensus Conference-2012: Recommendations on Trialing for Intrathecal (Intraspinal) Drug Delivery: Report of an Interdisciplinary Expert Panel [J].
Deer, Timothy R. ;
Prager, Joshua ;
Levy, Robert ;
Burton, Allen ;
Buchser, Eric ;
Caraway, David ;
Cousins, Michael ;
De Andres, Jose ;
Diwan, Sudhir ;
Erdek, Michael ;
Grigsby, Eric ;
Huntoon, Marc ;
Jacobs, Marilyn ;
Kim, Phillip ;
Kumar, Krishna ;
Leong, Michael ;
Liem, Liong ;
McDowell, Gladstone ;
Panchal, Sunil J. ;
Rauck, Richard ;
Saulino, Michael ;
Staats, Peter ;
Stanton-Hicks, Michael ;
Stearns, Lisa ;
Sitzman, B. Todd ;
Wallace, Mark ;
Willis, K. Dean ;
Witt, William ;
Yaksh, Tony ;
Mekhail, Nagy .
NEUROMODULATION, 2012, 15 (05) :420-435
[7]   Does the platelet function analyser (PFA-100®) predict blood loss after cardiopulmonary bypass? [J].
Fattorutto, M ;
Pradier, O ;
Schmartz, D ;
Ickx, B ;
Barvais, L .
BRITISH JOURNAL OF ANAESTHESIA, 2003, 90 (05) :692-693
[8]   Clinical Utility of the PFA-100 [J].
Favaloro, Emmanuel J. .
SEMINARS IN THROMBOSIS AND HEMOSTASIS, 2008, 34 (08) :709-733
[9]   Cyclooxygenase enzymes: Regulation and function [J].
Fitzpatrick, FA .
CURRENT PHARMACEUTICAL DESIGN, 2004, 10 (06) :577-588
[10]   Huge epidural hematoma after surgery for spinal cord stimulation [J].
Franzini, A ;
Ferroli, P ;
Marras, C ;
Broggi, G .
ACTA NEUROCHIRURGICA, 2005, 147 (05) :565-567