Risks and Complications of Neuraxial Anesthesia and the Use of Anticoagulation in the Surgical Patient

Abstract

Recognition of the risk of thromboembolic phenomena to patients in the postsurgical period has resulted in the practice of administering prophylactic anticoagulant agents to those patients who are at high risk for this complication. Institution of a perioperative anticoagulant or antithrombotic protocol needs to be considered when a regional anesthetic is proposed as part of, or as the total, anesthetic management of the patient. This article reviews current data on the risks involved in the use of neuraxial regional anesthesia in the care of surgical patients in whom prophylactic thromboembolic anticoagulant therapy is planned. Guidelines are established to help the physician minimize the risks of a neuraxial hematoma forming, monitor the patient for this complication, and optimally treat him or her if a hematoma were to occur.

Ultrasound‐guided femoral and sciatic nerve block as an option for below‐knee amputation in an elderly patient: A case report

“…6 However, regional anesthesia in the form of neuraxial blocks is associated with increased risks in patients with coagulopathy. 7 Use of peripheral nerve blocks for above-and below-knee amputation can be a very good option in patients with multiple comorbidities because of lesser hemodynamic changes and better pain management intra-and postoperatively. 8 Furthermore, no motor impairment and better pain control may help in early ambulation.…”

“…Regional anesthesia for lower limb surgeries is always an excellent option because of superior postoperative pain control, lesser opioid consumption and reduced opioid‐associated side effects, and lesser risks for hypoxia, respiratory depression, and no airway manipulation compared with general anesthesia 6 . However, regional anesthesia in the form of neuraxial blocks is associated with increased risks in patients with coagulopathy 7 . Use of peripheral nerve blocks for above‐ and below‐knee amputation can be a very good option in patients with multiple comorbidities because of lesser hemodynamic changes and better pain management intra‐ and postoperatively 8 .…”

Practical management of new oral anticoagulants after total hip or total knee arthroplasty

“…To minimize the risk of bleeding when anticoagulants are used together with epidural catheters, guidelines on the timing of catheter placement and withdrawal, in relation to dosing and peak plasma concentrations, are available for UFH, LMWHs, and VKAs [ 2 , 34 ]. All patients receiving anticoagulants, including fondaparinux, with regional anesthesia and postoperative indwelling epidural catheters should be closely monitored for signs and symptoms of neurological impairment [ 2 , 31 , 34 ].…”

Ultrasound–guided serratus anterior plane block versus thoracic epidural analgesia for acute post–thoracotomy pain: a prospective randomized controlled study

“…TEA is one of the gold standard techniques used for thoracotomy. [5][6][7][8][9] Additionally, opioids have many side effects, such as respiratory depression, constipation, and increased risk of postoperative nausea and vomiting. 10 Weaker analgesics, such as nonsteroidal anti-inflammatory analgesics, are not sufficient to treat the severe pain that accompanies thoracotomy and these also have many side effects, such as risk of peptic ulcers, gastrointestinal bleeding, and renal impairment.…”