To PDA/PDK

Epidural anaesthesia (PDA) is a procedure in which the anaesthetic is injected directly into the epidural space (also called the epidural space). For a single administration of the drug, a needle is inserted between the vertebral bodies and the anesthetic is injected directly. If the duration of the drug treatment is to last for a longer period of time, an epidural catheter (PDK) can be placed in addition to a stiff needle.

This thin tube made of plastic can remain in the epidural space for a longer period of time and allows the patient to be anesthetized repeatedly. Various complications can occur with intraspinal drug administration, including epidural bruising. If a vein lying in the epidural space is injured during the puncture, the bleeding usually stops on its own without corresponding symptoms.

If the bleeding does not stop on its own, a spinal hematoma forms which can cause neurological symptoms and, in the worst case, permanent damage to the spinal cord. With a probability of 1 in 150,000, however, such a complication is extremely rare and can be remedied by emergency surgery. Since coagulation disorders generally increase the risk of bleeding, bleeding during an epidural is also more frequent (probability 1 in 3000).

Symptoms

The symptomatology of epidural hematoma is very characteristic. After the patient has been injured, fainting follows in the majority of cases. After the patient has cleared up and regained consciousness, no symptoms may be noticeable.

A period of complete freedom from symptoms is not unusual. A mild headache often accompanies this period of rest and is often perceived as a minor symptom. In the course of the following 2 hours, the symptom construct slowly builds up.

The headache worsens and nausea (possibly with vomiting) sets in.This worsening of the condition should be alarming for the patient as well as for the treating persons and should result in hospitalization if this has not already happened. The consciousness clouds over again after a while and increased drowsiness dominates the patient’s appearance. The expansion of the hematoma causes progressive compression of the brain tissue.

Nerves can also be affected if they are located near the bleeding area. For example, unilateral pressure can cause the pupil to dilate (homolateral mydriasis), which is caused by involvement of the nervus occulomotorius, which is responsible for its control. On the opposite side of the body, motor disorders or even complete paralysis can occur, since the brain‘s control of movement is regulated in the opposite direction.

The symptoms of an epidural hematoma must be considered in a differentiated way in small children. Due to the low bone hardness, vessels can be more easily damaged by falls. The extensibility of the soft bones and the incompletely closed fontanelles leave the hematoma some leeway.

The first symptoms usually do not appear until 6 to 12 hours after the accident due to compensation of the expansion. The clinical picture is similar to that of an adult. In addition to neurological symptoms, blood loss in the circulatory system becomes more relevant in young children.

The size of the head allows a relatively large amount of blood to be absorbed, which can lead to a blood deficiency (anemia). The clinical picture of a spinal epidural hematoma is of course different. The consciousness of the patient remains unaffected as long as there is no additional injury to the head (combination of both injuries in severe car accidents is not unlikely, however).

Due to the increasing pressure on the spinal cord, localized pain occurs first before failures below the hematoma manifest themselves. A cross-sectional syndrome can be the consequence of the impact on the spinal cord, whereby the patient initially loses his motor skills and develops sensory disturbances. An operation can often restore the previous condition.