EXTRADURAL ABSCESS COMPLICATING EXTRADURAL ANAESTHESIA FOR CAESAREAN SECTION

Extradural abscess has been described infrequently as a complicationof extradural anaesthesia and analgesia. We describe an abscessthat developed 5 days after operation in a patient who had extraduralanaesthesia for Caesarean section and postoperative analgesia,and review the literature on extradural abscess complicatingextradural catheterization, including a discussion on patho-genesis,clinical presentation, diagnosis and management. There havenow been 16 reported cases of extradural catheter-related extraduralabscess. Only one previous case has been in obstetric practice,despite the widespread use of these techniques in this specialty.A disproportionate number of cases have involved thoracic catheters.Duration of catheterization ranged from 40 h to 6 weeks, themajority of catheters being in place for 5 days or less. Thetime from catheter placement to development of symptoms rangedfrom 72 h to 5 months. The causative organism was isolated in11 cases: Staphylococcus aureus was identified in nine (82%)and Staphylococcus epidermidis in two (18%). Outcome was reportedin 15 cases, of which seven (47%) had a full or near full recoveryand eight (53%) had a persistent neurological deficit. One casewas managed successfully without surgery. Fifty percent of allcases have been reported in the past 5 years. With the increasinguse of extradural techniques for anaesthesia and analgesia,this serious complication may be seen more frequently in thefuture.