Development of Psoas Hematoma After Lumbar Sympathetic Block in a Patient on Anticoagulants

Abstract

BACKGROUND: Lumbar sympathetic blocks (LSB) play an important role in the therapeutic management of patients who suffer from neuropathic pain conditions such as complex regional pain syndrome (CRPS). LSB is a generally safe and well-tolerated procedure, however rare complications may occur. While case reports of iliopsoas hematomas related to bleeding disorders, surgical interventions, and trauma are well reported in the literature, similar complications after LSB have not been reported. CASE REPORT: Development of an 18 x 6.1-cm hematoma in the left iliopsoas muscle after a fluoroscopically-guided LSB in an anticoagulated patient despite following recommended periprocedural anticoagulation management guidelines resulted in pain, impaired mobility, and likely femoral neuropathy. CONCLUSION: Pain management physicians should be aware that hematomas are a possible complication of LSB and should weigh the risks and benefits of holding anticoagulation therapy in patients undergoing such procedures. KEY WORDS: Anticoagulation, complex regional pain syndrome, hematoma, lumbar sympathetic block, lumbar sympathetic block complications