Peridural anaesthesia and anti-coagulant therapy

Abstract

A 70-year-old man with occlusion of the popliteal artery and progressive gangrene of the leg received peridural analgesia with an indwelling catheter. There was gratifying relief of pain. He was then started on anti-coagulant therapy. Symptoms of urinary incontinence, severe low back pain and faecal incontinence developed and persisted after withdrawal of the peridural catheter. The clinical impression of a cauda equina lesion causing this deficit was confirmed by myelography when an extradural compressive lesion was demonstrated at L4 level. At operation a peridural haematoma was evacuated from this site. Our experience with this complication of peridural anaesthesia is documented to caution against the use of this technique in patients who are receiving or who might subsequently receive anti-coagulant therapy. © 1974 Canadian Anesthesiologists.