Neuraxial and Perineural Bleeding after Neuraxial Techniques: An Overview of the Last Year

Abstract

Spinal hematoma following neuraxial or perineural techniques is a rare but severe complication that canpotentially lead to catastrophic consequences. The aim of this review is to analyze all reported cases ofneuraxial or perineural bleeding after performance of a locoregional technique since the last guidelinesupdate in 2018. We included articles indexed by MEDLINE, Scopus, and Google Scholar. We analyzed thepatient's age, surgical procedure, pre-operative anticoagulant and antiplatelet therapy, type of anestheticprocedure, vertebra level of the procedure, diameter and point type of the needle, hematoma type(spinal, subdural, epidural), signs and symptoms, time to imaging, and time to treatment and outcome.During our bibliographic research, we identified 5637 unique articles that were eligible according to ourprotocol criteria, identifying 18 separate cases of neuraxial bleeding. Although clinicians are usually awareof antiplatelet and anticoagulant perioperative management, a careful post-procedural observation anda detailed patient education are also imperative for the early detection of the symptoms of spinal cordischemia.