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Epidural haematoma — FRCA Final MCQ

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HardRegional AnaesthesiaEpidural haematomaFRCA Final

A 69-year-old man has total knee replacement under spinal anaesthesia. Six hours later he has severe back pain, new bilateral leg weakness and urinary retention. He received prophylactic low-molecular-weight heparin the evening before surgery and the epidural catheter has not been used. What is the most important next step?

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Correct answer: B — Arrange urgent MRI and spinal surgical review

New neurological deficit with back pain and bladder dysfunction after neuraxial technique is an epidural haematoma until proven otherwise. Urgent MRI and spinal surgical input are needed because neurological recovery depends on rapid decompression. Analgesia or delayed review risks permanent injury. Anticoagulant dosing should be withheld while emergency assessment is underway.

Reference: Association of Anaesthetists regional anaesthesia and coagulation guideline 2021