Hematoma After Transversus Abdominis Plane Block in a Patient With HELLP Syndrome

Abstract

We herein present a case of intramuscular hematoma that developed after transversus abdominis plane block in a patient undergoing cesarean delivery. The patient had HELLP syndrome (hemolysis, elevated liver enzymes, and low platelet count) preoperatively. Ultrasonography-guided transversus abdominis plane block was performed at the end of surgery. Postoperatively, the platelet count and antithrombin III level decreased, and computed tomography revealed intramuscular hematomas that possibly were related to vascular injury and potential disseminated intravascular coagulation. We should be mindful of the possibility of intramuscular hematoma formation in patients with HELLP syndrome, even when using ultrasound guidance.

Practice advisory on the bleeding risks for peripheral nerve and interfascial plane blockade: evidence review and expert consensus

“…After manual review, only reports of bleeding or aneurysmal complications and visceral or peritoneal injury were retained, yielding 16 relevant publications. [72][73][74][75][76][77][78][79][80][81][82][83][84][85][86][87] The reported complications from these articles are summarized in Table 8. A majority of the studies that prospectively examined complications following interfascial blocks were unclear in their approach to measurement and were excluded because data was lacking.…”

“…Two reports acknowledged bleeding-related complications after TAP block procedures including a case of vascular puncture 79 and an intramuscular hematoma in a patient with peripartum coagulopathy. 81 A total of four additional reports acknowledged non-bleeding but relevant complications related to TAP block procedures. 76,78,79,87 These included peritoneal puncture, 76,79 liver injury with peritonitis, 78,[87][88][89][90] and an unknown complication in a patient with a high BMI.…”

Erector spinae plane continuous blocks for pediatric liver transplantation

“…Placing the nerve block catheters deep to erector spinae muscle (an area not easily compressible) in a coagulopathic patient can result in perioperative bleeding. Long lasting hematoma-induced pain can increase medical costs and decrease patient and family satisfaction 5 6…”

Consideraciones anestésicas en el síndrome de HELLP

“…l síndrome de HELLP forma parte de las complicaciones severas de la preeclampsia, su nombre surge del acrónimo en inglés, de las alteraciones que lo definen: hemólisis, elevación de las enzimas hepáticas y plaquetopenia [1], [2], [3].…”

“…Hay cuatro tipos de trastornos hipertensivos relacionados con el embarazo: preeclampsia, hipertensión crónica, hipertensión gestacional y preeclampsia sobreagregada a hipertensión gestacional. El diagnóstico de preeclampsia se realiza por cifras de presión arterial mayores a 140/90 mmHg en dos tomas [1], [2], [3], [4], [6].…”