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British Journal of Anaesthesia, 1992, Vol. 69, No. 6 647-652
© 1992 The Board of Management and Trustees of the British Journal of Anaesthesia

case-report

EXTRADURAL ABSCESS COMPLICATING EXTRADURAL ANAESTHESIA FOR CAESAREAN SECTION

W. D. NGAN KEE, M.B., CH.B.1,*, M. R. JONES, M.D., M.R.C.PATH.2, P. THOMAS, F.R.C.ANAES.2 and R. J. WORTH, F.R.C.S.(ED.), F.R.A.C.S.2

1Section of Anaesthesia, Department of Surgery, Wellington School of Medicine P.O. Box 7343, Wellington, New Zealand
2Wellington Hospital Private Bag, Wellington, New Zealand

*Correspondence to W.D.N.K.

Extradural abscess has been described infrequently as a complication of extradural anaesthesia and analgesia. We describe an abscess that developed 5 days after operation in a patient who had extradural anaesthesia for Caesarean section and postoperative analgesia, and review the literature on extradural abscess complicating extradural catheterization, including a discussion on patho-genesis, clinical presentation, diagnosis and management. There have now been 16 reported cases of extradural catheter-related extradural abscess. 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, the majority of catheters being in place for 5 days or less. The time from catheter placement to development of symptoms ranged from 72 h to 5 months. The causative organism was isolated in 11 cases: Staphylococcus aureus was identified in nine (82%) and Staphylococcus epidermidis in two (18%). Outcome was reported in 15 cases, of which seven (47%) had a full or near full recovery and eight (53%) had a persistent neurological deficit. One case was managed successfully without surgery. Fifty percent of all cases have been reported in the past 5 years. With the increasing use of extradural techniques for anaesthesia and analgesia, this serious complication may be seen more frequently in the future.


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