In this issue of the Scandinavian Journal of Pain Michael Lagerkranser publishes two connected papers in which he analyses risk factors and management of 166 cases of bleeding into the spinal canal (spinal haematoma (SH)), rare complications that can damage the spinal cord, from epidural- or spinal-analgesia (central neuraxial blocks (CNB)) and from spinal cord stimulator (SCS) lead-electrodes [1,2]. These 166 case stories, published between 1994 and 2015, appeared in MEDLINE- or EMBASE-databases.1Why should we pay attention to case stories?We know that there are many sources of publication bias in case-stories where patients suffered major complications or death: we seldom see publications of cases where the author(s) clearly made a unforgivable blunder, more often the authors publish their case-story when rare complications happened in spite of apparently perfect handling before and after the complication occurred. Still, such case reports, but only when reported honestly and in enough detail to make it possible to analyse risk factors and management, can be the only way to learn critical aspects of rare events or rare but serious complications .2Randomized and controlled study (RCT) of rare events is hardly possibleSo, why can we not do large trials in which we can handle patients
Scandinavian Journal of Pain – de Gruyter
Published: Dec 29, 2017
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