- 期刊
Catheter-Related Epidural Abscess Formation after a Combined Spinal and Epidural Anesthesia for a Total Knee Arthroplasty: A Case Report
硬脊膜外膿瘍發生於一接受人工全膝關節置換術及硬脊膜外疼痛控制：一病例報告
並列摘要
Spinal epidural abscess formation is a rare but potentially devastating complication, which may occur after combined spinal and epidural analgesia. Early detection of infection and urgent decompression with drainage of abscess and antibiotics treatment are still the mainstay of management. Generally, the prognosis primarily depends on the neurological deficits at the time of diagnosis and most patients recover without neurological sequelae after adequate management. We present a 66-year-old male who underwent a total knee arthroplasty due to unremitting left knee pain. Combined spinal anesthesia and epidural analgesia was performed and epidural abscess developed on the sixth postoperative day. Urgent decompression with antibiotics treatment was given and four more debridements were performed due to methicillin-resistant Staphylococcus aureus infection and poor wound healing. Though there were no neurological sequelae and no septic loosening of total knee prosthesis found, prolonged hospitalization (94 days) and multiple operations were disastrous for the patient, family, and physicians. Invasive technique near the neuraxis is not without risk but meticulous aseptic technique during catheterization reduces the incidence of spinal infection. Early diagnosis and decompression are still the cornerstone of good outcome.