An epidural or spinal hematoma may develop following epidural or spinal anesthesia or spinal puncture. This can result in permanent paralysis if unrecognized. Certain risk factors can help identify a patient who should be more closely monitored for this complication.


Risk factors associated with increased bleeding tendency:

(1) anticoagulation with unfractionated or low molecular weight heparin

(2) nonsteroidal anti-inflammatory drugs (NSAIDS) or drugs with antiplatelet activity

(3) anticoagulation with coumadin

(4) herbal products with anti-platelet activity (garlic, ginkgo, ginseng, etc.)


Risk factors associated with traumatic injury:

(1) indwelling epidural catheter

(2) traumatic puncture

(3) repeated puncture


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