Hadzic's Peripheral Nerve Blocks and Anatomy for Ultrasound-Guided Regional Anesthesia, 2e > Section 1. Foundations of Peripheral Nerve Blocks > Chapter 8. Regional Anesthesia in the Anticoagulated Patient Honorio T. Benzon

Intraspinal Hematoma

"The incidence of intraspinal hematoma is approximately 0.1 per 100,000 patients per year.¹ It is more likely to occur in anticoagulated or thrombocytopenic patients, patients with neoplastic disease, or in those with liver disease or alcoholism.² The incidence of neurologic dysfunction resulting from hemorrhagic complications associated with neuraxial blockade is estimated to be <1 in 150,000 epidural procedures and <1 in 220,000 with spinal anesthetics. The risk of formation of intraspinal hematoma after administration of neuraxial injections is increased in patients who received anticoagulant therapy or have a coagulation disorder, technical difficulties in the performance of the neuraxial procedures due to anatomic abnormalities of the spine, and multiple or bloody punctures. The American Society of Regional Anesthesia and Pain Medicine (ASRA) issued recommended guidelines for the safe performance of neuraxial blocks in patients who are on anticoagulants.^3,4 The third edition of the ASRA guidelines was published in 2010...."