Inadvertent epidural administration of tranexamic acid without neurological sequelae: a case report

Inadvertent intrathecal administration of tranexamic acid can result in severe mortality and morbidity. Less is known about the consequences of inadvertent epidural administration of tranexamic acid in awake patients. Our patient inadvertendly received 810 mg (9 mL) of tranexamic acid instead of 1% lidocaine to lumbar epidural space, to provide analgesia for postpartum repair of perineal tears. No symptoms were experienced from the tranexamic acid dose, and anesthesia for the repair was provided with local administration of local anesthetics. The patient was monitored for four hours in the labor room without detectable neurologic symptoms, or changes in subjective well-being. She subsequently recovered from the delivery normally and experienced no symptoms within a four-week follow-up. Several system level risks contributed to medication error. Prevention of this type of medication error would require use of non-Luer connectors for neuraxial analgesia and use of pre-filled tranexamic acid syringes with Luer connectors.