Abstract: The actual incidence of neurologic dysfunction resulting

from hemorrhagic complications associated with neuraxial blockade is

unknown. Although the incidence cited in the literature is estimated to

be less than 1 in 150,000 epidural and less than 1 in 220,000 spinal

anesthetics, recent epidemiologic surveys suggest that the frequency is

increasing and may be as high as 1 in 3000 in some patient populations.

Overall, the risk of clinically significant bleeding increase with age,

associated abnormalities of the spinal cord or vertebral column, the

presence of an underlying coagulopathy, difficulty during needle placement,

and an indwelling neuraxial catheter during sustained anticoagulation

( particularly with standard heparin or low-molecular weight

heparin). The need for prompt diagnosis and intervention to optimize

neurologic outcome is also consistently reported.

In response to these patient safety issues, the American Society of

Regional Anesthesia and Pain Medicine (ASRA) convened its Third

Consensus Conference on Regional Anesthesia and Anticoagulation.

Practice guidelines or recommendations summarize evidence-based

reviews. However, the rarity of spinal hematoma defies a prospective

randomized study, and there is no current laboratory model. As a result,

the ASRA consensus statements represent the collective experience

of recognized experts in the field of neuraxial anesthesia and

anticoagulation. These are based on case reports, clinical series, pharmacology,

hematology, and risk factors for surgical bleeding. An

understanding of the complexity of this issue is essential to patient

management.