If you’re placing an epidural, how would you prevent the disaster?

The ASRA guidelines aim to prevent the risk of complications such as epidural hematoma after neuraxial blockade. However, there is no guarantee against such an event. There have been documented case reports of spontaneous epidural or spinal hematomas in patients who have not undergone any invasive neuraxial procedure. Early detection and neurological consultation and decompression within 8 hours are critical to reversal of neurologic deficit.

In the absence of any focal neurological deficits, conservative therapy and observation are warranted. However, if the patient exhibits any symptoms of progressively severe back pain with motor or sensory deficits, then a MRI/CT scan and emergency surgery should be performed expediently in order to reduce poor neurological outcome from the epidural hematoma.