Delayed psoas muscle hematoma formation after spinal anesthesia with the paramedian approach in a hemodialysis patient: A case report

Kim, Yeo Jung; Mun, Sung Ha; Choi, Won Jun; Kim, Yun Hong; Kim, Hyun Soo

Case Report

Spinal Pain

Anesthesia and Pain Medicine 2010;5(4):284-287.
Published online October 31, 2010.

Delayed psoas muscle hematoma formation after spinal anesthesia with the paramedian approach in a hemodialysis patient: A case report

Yeo Jung Kim, Sung Ha Mun, Won Jun Choi, Yun Hong Kim, Hyun Soo Kim

Department of Anesthesiology and Pain Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea. anesmun@hanmail.net

Abstract

We present a patient who developed a psoas muscle hematoma after spinal anesthesia. He had received hemodialysis with heparin every two days because of end stage renal disease. Under the jack-knife position, he underwent spinal anesthesia and a paramedian approach was used for incision and drainage of an anal abscess. The coagulation tests were normal throughout the surgery. Eleven days after the operation, he complained of sudden onset of right buttock pain and a psoas muscle hematoma was diagnosed by CT. Although heparin is recommended after regional anesthesia, it is a major cause of delayed hematoma. Because of this potential complication, anesthesiologists and clinicians should carefully monitor the usage of anticoagulants after spinal anesthesia, and it is necessary to use active diagnostic tools such as CT for early diagnosis when hematoma formation is suspected in patients receiving anticoagulants.

Key Words: Hematoma, Hemodialysis, Psoas, Spinal