J Meikle1, S Bird, J J Nightingale, N White. 1. Department of Anaesthesia, Basingstoke and North Hampshire Foundation Trust, Aldermaston Road, Basingstoke RG24 9NA, UK.
Abstract
BACKGROUND: Epidural haematoma is a rare, but potentially disastrous complication of epidural analgesia. Favourable neurological outcome depends upon early recognition and surgical decompression; therefore, the management of epidural analgesia should include a systematic approach to recognition of the signs of epidural haematoma. METHODS: We conducted a national postal survey of the policies and protocols used by acute pain services for investigating clinical signs suggestive of epidural haematoma, and the availability of urgent MRI scans. This was a repeat of a survey that was carried out in 2001, but not published. RESULTS: The response rate was 84%. Of the acute pain services that responded, 99% have a written protocol for running epidural infusions, 91% include regular assessment of sensory and motor function, and 55% have a written protocol for the investigation of abnormal motor block. On-site 24 h access to MRI scanning facilities was available to 57%, 33% have arrangements with another hospital, and 10% do not have 24 h access to MRI. Thirty per cent of respondents knew of an epidural haematoma related to epidural analgesia in their hospital, one-third of which were not diagnosed and treated within 24 h. CONCLUSIONS: Improvements in monitoring have occurred over the last 5 yr, but observations of neurological function are not routine in all units, and are not continued after removal of the epidural catheter in the majority. The authors suggest that acute pain services should be responsible for protocols for the investigation and treatment of epidural haematomas.
BACKGROUND: Epidural haematoma is a rare, but potentially disastrous complication of epidural analgesia. Favourable neurological outcome depends upon early recognition and surgical decompression; therefore, the management of epidural analgesia should include a systematic approach to recognition of the signs of epidural haematoma. METHODS: We conducted a national postal survey of the policies and protocols used by acute pain services for investigating clinical signs suggestive of epidural haematoma, and the availability of urgent MRI scans. This was a repeat of a survey that was carried out in 2001, but not published. RESULTS: The response rate was 84%. Of the acute pain services that responded, 99% have a written protocol for running epidural infusions, 91% include regular assessment of sensory and motor function, and 55% have a written protocol for the investigation of abnormal motor block. On-site 24 h access to MRI scanning facilities was available to 57%, 33% have arrangements with another hospital, and 10% do not have 24 h access to MRI. Thirty per cent of respondents knew of an epidural haematoma related to epidural analgesia in their hospital, one-third of which were not diagnosed and treated within 24 h. CONCLUSIONS: Improvements in monitoring have occurred over the last 5 yr, but observations of neurological function are not routine in all units, and are not continued after removal of the epidural catheter in the majority. The authors suggest that acute pain services should be responsible for protocols for the investigation and treatment of epidural haematomas.