We describe a case of acute lumbar epidural hematoma at the L2-3 level complicated by paraplegia, which occurred after coagulation disorder because of massive bleeding intraoperatively in cesarean section. The preoperative coagulation laboratory finding was in normal range and so we tried combined spinal epidural anesthesia. Uterine atony occurred in the operation, and there was persistant bleeding during and after the operation. After the operation, she complained of paresthesia on her both legs and was diagnosed with epidural hematoma (EDH) by radiologic examination. Emergency laminectomy on lumbar spine was carried out for hematoma evacuation and decompression of the epidural space at once. In our experience, massive bleeding during surgery may potentially increase the risk of EDH postoperatively.
Anesthesia, Epidural ; Anesthesia, Spinal ; Blood Coagulation Disorders ; Cesarean Section ; Decompression ; Emergencies ; Epidural Space ; Female ; Hematoma ; Hemorrhage ; Laminectomy ; Leg ; Paraplegia ; Paresthesia ; Postpartum Hemorrhage ; Pregnancy ; Reference Values ; Spine ; Uterine Inertia

Stellate ganglion block (SGB) is a procedure that is widely used for many diseases associated with sympathetically-maintained pain in the head, neck, and upper extremities. Various hemodynamic changes may occur after SGB. Among them, we experienced two patients who developed highly increased blood pressure after SGB. We suspect that the spread of local anesthetics produced parasympathetic blockade of the vagus nerve, an imbalance between the sympathetic and parasympathetic activities and deafferentiation of the glossopharyngeal and vagus nerve, which both innervated the carotid sinus, as the mechanism of this increased blood pressure.
Anesthetics, Local ; Blood Pressure ; Carotid Sinus ; Head ; Hemodynamics ; Humans ; Neck ; Stellate Ganglion ; Upper Extremity ; Vagus Nerve