TITLE:
Psoas Hematoma Following Lumbar Sympathetic Block in a Patient with Renal and Liver Diseases and Recent Use of Aggrenox
AUTHORS:
Nashaat Rizk, Zirong Zhao, Munish Loomba
KEYWORDS:
Psoas Hematoma, Lumbar Sympathetic Block, Antiplatelet, Aspirin, Dipyridamole
JOURNAL NAME:
Open Journal of Anesthesiology,
Vol.4 No.4,
April
18,
2014
ABSTRACT: Lumbar sympathetic block is an analgesic
procedure frequently performed in chronic pain clinics for ischemic lower limb
pain from peripheral arterial disease. Although the lumbar
sympathetic ganglia are anatomically near major vascular and neural structures,
complications such as severe hemorrhage is rarely reported. Aspirin/extended
release dipyridamole (Aggrenox) is indicated for secondary stroke prevention.
Stroke is frequently a co-morbid condition in patients with peripheral vascular
disease. Interventional pain physicians frequently face the difficulty of
deciding whether to continue or stop antithrombotic medications in the
periprocedural period because of the devastating consequences of both hemorrhagic
and thrombotic complications. Due to a paucity of data, no guidelines have been
specifically written for interventional procedures for chronic pain. To aid
future decision making, we present a case report of psoas hematoma developed
after lumbar sympathetic block in a patient with end stage renal failure and
hepatic dysfunction who had limb-threatening ischemia. The patient was treated
with Aggrenox until three days before the procedure.