Anaesthetists Handbook - MEDICAL EDUCATION at University ...

Epidural anaesthesia and analgesiaManagement of suspected epidural haematomaAn epidural haematoma will usually cause severe back pain, wherethe haematoma is compressing the spinal cord. This pain will radiatearound the body like a belt and below this level there may be achange in neurology. This means the patient may no longer be ableto move or feel pressure or touch, when they could previously.There may be some ‘normal’ block above this belt of pain.An epidural haematoma is an emergency and must bedecompressed as soon as possible or permanent paralysis will resultand the following steps must be taken if this is suspected:1. Immediately call the on-call anaesthetist and registrar of primaryteam.2. Examine neurology.3. Call on-call neurosurgical registrar and inform on-call consultantanaesthetist.4. Arrange MRI scan.5. If MRI scan confirms compression arrange theatre fordecompression within four hours.Securing a catheterThe secure fixation of an epidural catheter will reduce the risk of itfalling out and reduce the risk of skin irritation.1. Skin preparation should be with chlorhexidine in spirit. Iodinesolutions are contraindicated if Opsite spray is being used as itmay cause burns. Iodine solution is neurotoxic and may enterthe spinal or epidural space on the epidural needle.2. The solution should be allowed to fully evaporate to ensureasepsis.134 Anaesthetists Handbook January 2010