To the Editor:-Vac largest single group of patients receiving central blockades worldwide is undoubtably parturients. Fortunately, serious complications are rare, as pointed out in two recent studies published in Anesthesiology. Ruppen et al. found six epidural hematomas and justly considered these numbers inadequate to produce a robust estimate of event rates. Because of their study design, several cases reported in the literature are excluded from the statistical calculation performed in the meta-analysis. For example, the Closed Claims project included three spinal hematomas in obstetric patients. Many other excluded cases occurred in patients with impaired coagulation due to preeclampsia or large blood loss, conditions that might predispose even to a spontaneous spinal hematoma.Nonetheless, despite frequent bloody taps and thrombocytopenia, spinal hematoma is rare in obstetric patients. The compliant spinal canal in a young individual permits the introduction of volumes that may cause severe symptoms and permanent damage in an older person with a stenotic spinal canal.
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