Epidural anesthesia prevents hypercoagulation in patients undergoing major orthopedic surgery

Hollmann, Markus W.; Wieczorek, Kathrin; Smart, Mary; Durieux, Marcel E.

doi:10.1053/rapm.2001.23209

Cited by 28 publications

(12 citation statements)

References 22 publications

(24 reference statements)

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“…Studies showed favorable results Opperer M et al . Perioperative outcomes of anesthesia in hip surgery coagulation parameters were reported as not significantly altered from baseline [45] . Observational studies have failed to this day to show differences in homeostatic markers undergoing general or neuraxial anesthesia, leaving the reasons for the observed clinical differences to be discussed and studied [46] .…”

Section: Blood Loss and Transfusion Needmentioning

confidence: 90%

Perioperative outcomes and type of anesthesia in hip surgical patients: An evidence based review

Opperer

Danninger

Stundner

et al. 2014

WJO

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Over the last decades the demand for hip surgery, be it elective or in a traumatic setting, has greatly increased and is projected to expand even further. Concurrent with demographic changes the affected population is burdened by an increase in average comorbidity and serious complications. It has been suggested that the choice of anesthesia not only affects the surgery setting but also the perioperative outcome as a whole. Therefore different approaches and anesthetic techniques have been developed to offer individual anesthetic and analgesic care to hip surgery patients. Recent studies on comparative effectiveness utilizing population based data have given us a novel insight on anesthetic practice and outcome, showing favorable results in the usage of regional vs general anesthesia. In this review we aim to give an overview of anesthetic techniques in use for hip surgery and their impact on perioperative outcome. While there still remains a scarcity of data investigating perioperative outcomes and anesthesia, most studies concur on a positive outcome in overall mortality, thromboembolic events, blood loss and transfusion requirements when comparing regional to general anesthesia. Much of the currently available evidence suggests that a comprehensive medical approach with emphasis on regional anesthesia can prove beneficial to patients and the health care system.

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Section: Blood Loss and Transfusion Needmentioning

confidence: 90%

Perioperative outcomes and type of anesthesia in hip surgical patients: An evidence based review

Opperer

Danninger

Stundner

et al. 2014

WJO

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“…There is a lack of robust evidence regarding postoperative outcomes to inform the choice of anesthetic technique. Regional anesthesia has been hypothesized to decrease postoperative complications by reducing sympathetic activation and inflammation, by preventing venous stasis, and by avoiding tracheal intubation and positive pressure ventilation [6][7][8] . However, to our knowledge, the influence of anesthesia type on clinical outcomes has not been studied with large clinical trials, and the investigations that have been done have produced conflicting results [9][10][11] .…”

mentioning

confidence: 99%

“…Third, the estimated prevalences of each of the individual complications included in the composite outcomes were consistently lower for patients who received regional anesthesia, suggesting benefit across complications. Fourth, the results are biologically plausible, as regional techniques and drugs block sympathetic nerve activity, reduce cytokine production, and inhibit platelet function 7,8 . This study has important limitations.…”

mentioning

confidence: 99%

Effects of Regional Versus General Anesthesia on Outcomes After Total Hip Arthroplasty

Helwani

Avidan

Abdallah

et al. 2015

The Journal of Bone and Joint Surgery-American Volume

151

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“…The use of a tourniquet was shown to result in an increase in blood pressure in anesthetized horses; the cause of the increased blood pressure was thought to be pain induced by hypoxia (Abrahamsen et al 1989, Copland et al 1989. In human medicine, pain caused by a tourniquet and surgical manipulation of tissues resulted in an increase in systemic coagulation, which could be inhibited by concurrent extradural anesthesia (Hollmann et al 2001, Kohro et al 1998. It is known that microthrombi occur in laminitis (Weiss et al 1998;1997;1995) but whether the use of a tourniquet is a risk factor for this is not known.…”

Section: Discussionmentioning

confidence: 99%

Atypical laminitis after orthopedic surgery in eight horses

Widmer¹,

Kummer²,

Bettschart‐Wolfensberger³

et al. 2009

PHK

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SummaryA retrospective study was carried out to investigate the prevalence and causes of laminitis affecting limbs other than the contralateral healthy limb after orthopedic surgery in horses. Of 3,500 horses referred for orthopedic surgery at the Equine Clinic, Vetsuisse-Faculty, University of Zurich, between 1992 and 2007, eight horses that developed laminitis in one or more limbs, but not primarily the contralateral limb, were identified. The reasons for referral were synovial space infection (n = 4), pastern joint arthrodesis (n = 1), fracture of the central tarsal bone (n = 1), bilateral stifle osteochondrosis (n = 1) and luxation of the superficial digital flexor tendon (n = 1). Postoperative complications included infection of the surgery site (n = 1), severe postoperative pain (n = 2), postoperative myopathy (n = 1), urticaria (n = 1) and cecal impaction (n = 1). The administration of analgesics was discontinued eight days after surgery because of urticaria in one horse and one day after surgery because of cecal impaction in another horse. Seven of the eight horses were euthanized because of severe laminitis. Elimination of infection and effective postoperative analgesia appear important in the prevention of laminitis. Severe postoperative pain should be prevented with adequate, continuous and multimodal pain management. It should also be noted that laminitis may occur in response to excessive weight bearing in limbs other than the contralateral limb after orthopedic surgery.Keywords: laminitis, horse, orthopedic surgery, orthopedics, surgery Atypische Hufrehe nach orthopädischen Operationen bei 8 PferdenEs handelt sich in dieser Fallserie um eine retrospective Studie über die Häufigkeit der Entwicklung von Hufrehe nach orthopädischen Eingriffen, welche nicht primär die kontralaterale Gliedmaße betrifft. Von 3500 Pferden, welche für einen orthopädischen Eingriff an die Pferdeklinik der Vetsuisse-Fakultät der Universität Zürich zwischen 1992 und 2007 überwiesen wurden, entwickelten 8 Pferde eine Hufrehe, welche nicht primär das kontralaterale Bein betraf. Die Gründe der Einlieferung waren synoviale Infektionen (n=4), Krongelenksarthrodese (n=1), Fraktur des os tarsi centrale (n=1), bilaterale Osteochondrose im Kniegelenk (n=1), und Fersenkappenluxation (n=1). Vor dem Eintreten der Hufrehe traten postoperativ folgende Komplikationen auf: Nahtinfektion (n=1), starke postoperative Schmerzen (n=2), postoperative Myopathie (n=1), Urtikaria (n=1) und Caecumobstipation (n=1). Bei einem Pferd wurden die Analgetika 8 Tage und bei einem anderen Pferd einen Tag nach der Operation abgesetzt infolge Urikaria beim ersten und Caecumobstipation beim zweiten Pferd. Sieben der acht Pferde wurden wegen hochgradiger Hufrehe euthanasiert. Die effektive Elimination von Infektionen und gute postoperative Analgesie sind von großer Wichtigkeit, um eine Hufrehe zu verhindern. Starke postoperative Schmerzen sollten durch adäquates und kontinuierliches multimodales Schmerz-Management verhindert werden. Es muss ebenfalls beachtet wer...

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Epidural anesthesia prevents hypercoagulation in patients undergoing major orthopedic surgery

Abstract: Use of EA prevents immediate postoperative hypercoagulability without affecting physiologic aggregation and coagulation processes. Also, CSA appears useful in predicting hypercoagulability and detecting platelet dysfunction. Reg Anesth Pain Med 2001;26:215-222.

Cited by 28 publications

References 22 publications

Perioperative outcomes and type of anesthesia in hip surgical patients: An evidence based review

Perioperative outcomes and type of anesthesia in hip surgical patients: An evidence based review

Effects of Regional Versus General Anesthesia on Outcomes After Total Hip Arthroplasty

Atypical laminitis after orthopedic surgery in eight horses

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