Epidural haematoma following anticoagulant treatment in a patient with an indwelling epidural catheter

We report the occurrence of an epidural haematoma after the removal of a lumbar epidural catheter, which had been inserted 2 days previously for surgery to revise a thrombosed femoral–popliteal graft. Pre-operatively the patient received intravenous heparin by infusion, but this was stopped 7 h prior to epidural insertion. Coagulation studies were normal. The epidural catheter insertion was unremarkable. Postoperatively, the patient received a continuous epidural infusion of fentanyl (3 μg.ml⁻¹) and bupivacaine (0.0625%), in addition to systemic anticoagulant therapy with heparin. On the second postoperative day, the patient was noted to have developed bilateral leg weakness (following transfer to another department for Doppler studies). The epidural catheter was inadvertently removed while the patient was anticoagulated and paraparesis developed overnight. After a significant delay, an epidural haematoma was diagnosed and treated by decompressive laminectomy. At operation an epidural haematoma extending posteriorly from T₁₂ to L₃ was removed.