Two cases of epidural hematoma had different outcomes before and after implementation of a protocol to manage epidural hematomas following epidural anesthesia

Abstract

An 80-year-old man underwent a transverse colectomy under combined epidural and general anesthesia. On the first postoperative day (POD), he complained of reduced sensation in the right leg and motor weakness. On the second POD, his symptoms progressed to paraplegia and analgesia below Th6. An epidural hematoma was observed using magnetic resonance imaging (MRI) on the third POD. An emergent laminectomy was performed, but the neurological deficits did not improve. We developed a protocol for the early diagnosis and management of epidural hematomas following this case. Five years later, a man in his 70s underwent bypass surgery for duodenal stenosis under combined epidural and general anesthesia. On the fourth POD, he complained of back pain and subsequently had paraplegia and analgesia below Th6. An emergent MRI, performed in accordance with the protocol, revealed an epidural hematoma. The symptoms disappeared immediately after removal of the hematoma. We suggest that it is necessary to establish a protocol for the management of epidural hematomas.