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Thromb Haemost 1999; 82(02): 913-918
DOI: 10.1055/s-0037-1615932
Research Article
Schattauer GmbH

Anticoagulation in the Setting of Epidural or Spinal Anesthesia/Analgesia

Gale E. Thompson
1   Department of Anesthesiology, Virginia Mason Medical Center, Seattle, WA, USA
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Publication Date:
09 December 2017 (online)

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Introduction

The focus of this chapter is on the word “analgesia,” as used in the title. Although the traditional role of the anesthesiologist is to provide anesthesia, or total pain relief, for surgical procedures in the operating room, it is no longer possible to be considered a “compleat” anesthesiologist by ending patient care at the time that the surgical patient is turned over to the recovery room nurse. There is a growing specialty and societal expectation that the anesthesiologist will smooth the pathway for recovery by using specific drugs and techniques to control postoperative pain. Usually the postoperative period includes a period of 1 to 5 days.

Why has the treatment of postoperative pain become such an issue? Can postoperative pain be effectively controlled in a more cost-effective manner than through the use of parenteral narcotics? In reality, narcotic drugs are not a cheap or effective approach. For example, any patient or nurse who has experienced post-thoracotomy pain control via the epidural route vs parenteral injections will testify to a preference for the epidural.1,2 When pain treatment is effective, there are multiple physiologic and economic spin-offs, such as better wound healing, decreased pulmonary infection rates, improved gastrointestinal function, shortened hospitalization time, and considerable savings of health care dollars.3-7

 

  • References

  • 1 Scott NB, Mogensen T, Bigler D, Lund C, Kehlet H. Continuous thoracic extraural 0.5% bupivacaine with or without morphine: effect on quality of blockade, lung function and the surgical stress response. Br J Anaesth 1989; 62: 253-257.
    CrossrefPubMedGoogle Scholar
  • 2 George KA, Wright PMC, Chisakuta A. Continuous thoracic epidural fentanyl for post-thoracotomy pain relief: with or without bupivacaine?. Anaesthesia 1991; 46: 732-736.
    CrossrefPubMedGoogle Scholar
  • 3 Kehlet H. Surgical stress: the role of pain and analgesia. Br J Anaesth 1989; 63: 189-195.
    CrossrefPubMedGoogle Scholar
  • 4 Tønnesen E, Wahlgreen C. Influence of extradural and general anaesthesia on natural killer cell activity and lymphocyte subpopulations in patients undergoing hysterectomy. Br J Anaesth 1988; 60: 500-507.
    CrossrefPubMedGoogle Scholar
  • 5 Hendolin H, Lahtinen J, Lansimies E, Tuppurainen T, Partanen K. The effect of thoracic epidural analgesia on respiratory function after cholecystectomy. Acta Anaesthesiol Scand 1987; 31: 645-651.
    CrossrefPubMedGoogle Scholar
  • 6 Yeager MP, Glass DD, Neff RK, Brinck-Johnsen T. Epidural anesthesia and analgesia in high-risk surgical patients. Anesthesiology 1987; 66: 729-736.
    CrossrefPubMedGoogle Scholar
  • 7 Erskine R, Janicki PK, Ellis P, James MF. Neutrophils from patients undergoing hip surgery exhibit enhanced movement under spinal anaesthesia compared with general anaesthesia. Can J Anaesth 1992; 39: 905-910.
    CrossrefPubMedGoogle Scholar
  • 8 Thompson GE. Regional anesthesia and central mechanisms of pain. In: Refresher Courses in Anesthesiology. Barash PG. ed. Philadelphia: J.B. Lippincott; 1990: 287-298.
    Google Scholar
  • 9 Woolf CJ, Chong MS. Preemptive analgesia - treating postoperative pain by preventing the establishment of central sensitization. Anesth Analg 1993; 77: 362-379.
    CrossrefPubMedGoogle Scholar
  • 10 Cousins MD, Mather LE. Intrathecal and epidural administration of opioids. Anesthesiology 1989; 61: 276-310.
    PubMedGoogle Scholar
  • 11 Rosenberg PH, Herris H, Scheinin B. Comparison of intramuscular analgesia, intercostal block, epidural morphine and on demand i.v. fentanyl in the control of pain after upper abdominal surgery. Acta Anaesthesiol Scand 1984; 28: 603-607.
    CrossrefPubMedGoogle Scholar
  • 12 Mahoney O, Noble PC, Davidson J, Tullos HS. The effect of continuous epidural analgesia on postoperative pain, rehabilitation, and duration of hospitalization in total knee arthroplasty. Clin Orthop 1990; 260: 30-37.
    PubMedGoogle Scholar
  • 13 Skouen JS, Wainapel SF, Willock MM. Paraplegia following epidural anesthesia. A care report and a literature review. Acta Neurol Scand 1985; 72: 437-443.
    PubMedGoogle Scholar
  • 14 Kane RE. Neurologic deficits following epidural or spinal anesthesia. Anesth Analg 1981; 60: 150-61.
    PubMed
  • 15 Rabito SF, Ahmed S, Feinstein L, Winnie AP. Intrathecal bleeding after the intraoperative use of heparin and urokinase during continuous spinal anaesthesia. Anesth Analg 1996; 82: 409-411.
    PubMedGoogle Scholar
  • 16 Metzger G, Singbartl G. Spinal epidural hematoma following epidural anesthesia versus spontaneous spinal subdural hematoma. Two case reports. Acta Anaesthesiol Scand 1991; 35: 105-107.
    CrossrefPubMedGoogle Scholar
  • 17 Odoom JA, Sih IL. Epidural analgesia and anticoagulant therapy. Experience with one thousand cases of continuous epidurals. Anaesthesia 1983; 38: 254-259.
    PubMedGoogle Scholar
  • 18 Baron HC, LaRaja RD, Rossi G, Atkinson D. Continuous epidural analgesia in the heparinized vascular surgical patient: a retrospective review of 912 patients. J Vasc Surg 1987; 6: 144-146.
    CrossrefPubMedGoogle Scholar
  • 19 Rao TL, El-Etr AA. Anticoagulation following placement of epidural and subarachnoid catheters: an evaluation of neurologic sequelae. Anesthesiology 1981; 55: 618-620.
    CrossrefPubMedGoogle Scholar
  • 20 Vandermeulen EP, Van Aken H, Vermylen J. Anticoagulants and spinal-epidural anesthesia. Anesth Analg 1994; 79: 1165-1177.
    PubMedGoogle Scholar
  • 21 Horlocker TT, Wedel DJ, Schroeder DR, Rose SH, Elliott BA, McGregor DG, Wong GY. Preoperative antiplatelet therapy does not increase the risk of spinal hematoma associated with regional anesthesia. Anesth Analg 1995; 80: 303-309.
    PubMedGoogle Scholar
  • 22 Horlocker TT, Heit JA. Low molecular weight heparin: biochemistry, pharmacology, perioperative prophylaxis regimens, and guidelines for regional anesthetic management. Anesth Analg 1997; 85: 874-885.
    CrossrefPubMedGoogle Scholar
  • 23 Bergqvist D, Lindblad B, Mätzsch T. Low molecular weight heparin for thromboprophylaxis and epidural/spinal anaesthesia – is there a risk?. Acta Anaesthesiol Scand 1992; 36: 605-609.
    CrossrefPubMedGoogle Scholar
  • 24 Steele SM, Slaughter TF, Greenberg CS, Reves JG. Epidural anesthesia and analgesia: implications for perioperative coagulability. (Editorial.). Anesth Analg 1991; 73: 683-685.
    PubMedGoogle Scholar
  • 25 Breivik H. Safe perioperative spinal and epidural analgesia: importance of drug combinations, segmental site of injection, training and monitoring. Acta Anaesthesiol Scand 1995; 39: 869-871.
    CrossrefPubMedGoogle Scholar
  • 26 Singelyn FJ, Deyaert M, Joris D, Pendeville E, Gouverneur JM. Effects of intravenous patient-controlled analgesia with morphine, continuous epidural analgesia and continuous three-in-one block on postoperative pain and knee rehabilitation after unilateral total knee arthroplasty. Anesth Analg 1998; 87: 88-92.
    PubMedGoogle Scholar
  • 27 Thompson GE, Hecker BR. Peripheral nerve blocks for management of thoracic surgical patients. In: Gravlee GP, Rauck RL. eds. Pain Management in Cardiothoracic Surgery. Philadelphia: JB Lippincott; 1993: 25-56.
    Google Scholar
  • 28 McLaren AD, Stockwell MC, Reid VT. Anesthetic techniques for surgical correction of fractured neck of femur. Anaesthesia 1978; 33: 1-14.
    CrossrefPubMedGoogle Scholar
  • 29 Modig J. Regional anaesthesia and blood loss. Acta Anaesthesiol Scand 1988; 89 (Suppl) 44-48.
    PubMedGoogle Scholar
  • 30 Rosenfeld BA, Beattie C, Christopherson R, Norris EJ, Frank SM, Breslow MJ, Rock P, Parker SD, Gottlieb SO, Perler BA. et al. The effects of different anesthetic regimens on fibrinolysis and the development of postoperative arterial thrombosis. Anesthesiology 1993; 79: 435-443.
    CrossrefPubMedGoogle Scholar
  • 31 Tuman KJ, McCarthy RJ, March RJ, DeLaria GA, Patel RV, Ivankovich AD. Effects of epidural anesthesia and analgesia on coagulation and outcome after major vascular surgery. Anesth Analg 1991; 73: 696-704.
    PubMedGoogle Scholar
  • 32 Christopherson R, Beattie C, Frank SM, Norris EJ, Meinert CL, Gottlief SO, Yates H, Rock P, Parker SD, Perler BA. et al. Perioperative morbidity in patients randomized to epidural or general anesthesia for lower extremity vascular surgery. Anesthesiology 1993; 79: 422-434.
    CrossrefPubMedGoogle Scholar