A case of acute epidural hematoma after epidural block for a patient taking ticlopidine hydrochloride that could not be confirmed beforehand

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  • 未然に抗血小板薬の投与を把握することができなかった硬膜外ブロック後の急性硬膜外血腫の1例
  • 症例 未然に抗血小板薬の投与を把握することができなかった硬膜外ブロック後の急性硬膜外血腫の1例
  • ショウレイ ミゼン ニ コウケッショウバンヤク ノ トウヨ オ ハアク スル コト ガ デキナカッタ コウマク ガイ ブロック ゴ ノ キュウセイコウマク ガイ ケッシュ ノ 1レイ

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We report here a case of acute epidural hematoma after epidural anesthesia for a patient taking ticlopidine hydrochloride. An 80-year-old woman with a history of atrial fibrillation and cerebral infarction was referred to our hospital for postherpetic neuralgia. Neither the patient nor the former physician was aware of the ticlopidine hydrochloride intake. Epidural anesthesia at level Th4/5 was therefore performed without a proper withdrawal period. Eight hours after puncture, leg movement disorder developed with loss of thermal nociception and tactile sensation, further followed by paraplegia. Because the symptoms did not resolve, an MRI scan was taken 3 days later, which revealed an epidural hematoma from level Th2 to Th11. No surgical treatment was performed. Epidural hematoma is a rare but severe complication of epidural anesthesia; thus appropriate withdrawal of anticoagulant and antiplatelet drugs is crucial before a procedure. A thorough interview is also necessary in elderly patients or patients with a history of cerebral infarction and atrial fibrillation.

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