[Epidural bleeding after labor epidural analgesia]

Abstract

Anaesthetists often stand in the front line to manage postpartum neurological deficits, although epidural analgesia is rarely responsible for these complications. An epidural analgesia was performed to relieve pain during spontaneous labor in a 34-year-old parturient. An emergency C-section was subsequently required due to fetal heart rate abnormalities. Twelve hours after catheter removal, the parturient developed a severe right leg motor and sensory neurological deficit, predominant on L5 and S1 roots and diagnosed by a neurologist as a central nerve root injury. Lumbar MRI identified a non-compressive epidural bleeding in front of the L5 vertebral body. Epidural bleeding after labor epidural analgesia is a rare complication that may jeopardize the functional prognosis. It may be difficult in some cases to differentiate an upper plexus injury due to labor and delivery from a central epidural analgesia-related nerve root lesion. Fetal head compression at the pelvic brim may induce neurological deficits in several well-differentiated nervous territories, thus mimicking an anaesthetic-induced perimedullar radiculopathy.

Keywords: Analgésie péridurale; Anti-inflammatoires non stéroïdiens; Déficit neurologique; Epidural analgesia; Epidural bleeding; Héparine de bas poids moléculaire; Low-molecular weight heparin; Lumbosacral plexus; Neurological deficit; Nonsteroidal anti-inflammatory drugs; Obstetrical labor; Plexus lombosacré; Post-partum; Postpartum; Saignement péridural; Travail obstétrical.