Abstract
Unfractionated heparin is used for the prevention of venous thromboembolism before, during, and after surgery, especially in high-risk patients. Epidural bleeding is the major complication of anticoagulant therapy during epidural analgesia. The calculated incidence of epidural hematoma is approximated to be less than 1 in 150,000 epidurals. However, this incidence is increased by anticoagulant therapy. The symptoms of acute epidural hematoma include a sharp radiating back pain and sensory and motor deficits. In most of the patients who had good recovery of neurologic function, emergency decompressive laminectomies were performed within 8 hours of the development of paraplegia. The following precautions are recommended to be taken : (1) epidural block should be avoided in patients with known coagulopathy from any cause ; (2) time from epidural to systemic heparinization should exceed 1 hour ; (3) epidural opioid with or without lower dose of local anesthetic should be used for early detection of paraplegia ; and (4) epidural catheter should be removed when normal coagulation is restored.
