Summary
A 70-year-old man with occlusion of the popliteal artery and progressive gangrene of the leg received peridural analgesia with an indwelling catheter. There was gratifying relief of pain. He was then started on anti-coagulant therapy. Symptoms of urinary incontinence, severe low back pain and faecal incontinence developed and persisted after withdrawal of the peridural catheter. The clinical impression of a cauda equina lesion causing this deficit was confirmed by myelography when an extradural compressive lesion was demonstrated at L4 level. At operation a peridural haematoma was evacuated from this site. Our experience with this complication of peridural anaesthesia is documented to caution against the use of this technique in patients who are receiving or who might subsequently receive anti-coagulant therapy.
Résumé
Nous avons fait une analgésie péridurale avec un catheter à un homme de 70 ans qui souffrait ďune occlusion de ľartère poplitée et ďune gangrène progressive de la jambe. Il s’en suivit un soulagement bienfaisant. On commença alors une thérapie aux anticoagulants. Sont apparues et ont continué ďexister après avoir enlevé le catheter: une incontinence urinaire, de pénibles douleurs au bas du dos et de ľincontinence des selles. Nous avions ľimpression clinique que ce syndrome était dû à une lésion de la queue de cheval, ce que confirma une myélographie qui mit en évidence, en L 4, un lésion compressive extradurale. A ľopération, de cet endroit, on a évacué un hématome péridural.
Devant cette complication vécue avec ľanesthésie péridurale, nous conseillons la prudence dans ľusage de cette technique chez les malades recevant ou susceptibles de recevoir ultérieurement une thérapie aux anti-coagulants.
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Varkey, G.P., Brindle, G.F. Peridural anaesthesia and anti-coagulant therapy. Can. Anaesth. Soc. J. 21, 106–109 (1974). https://doi.org/10.1007/BF03004585
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DOI: https://doi.org/10.1007/BF03004585