Role of Extradural and of General Anaesthesia in Fibrinolysis and Coagulation After Total Hip Replacement

Abstract

Thirty patients undergoing total hip replacement were randomly allocated to one of two groups. One group (n = 14) received extradural anaesthesia with 0.5% bupivacaine with adrenaline continued into the postoperative period (24 h) for pain relief. The other group (n = 16) received general anaesthesia with controlled ventilation, using nitrous oxide in oxygen and fentanyl i.v. Following surgery they received a narcotic analgesic i.m. on demand. Analysis of fibrinolysis inhibition activity and plasminogen activators revealed a significantly better fibrinolytic function in patients given continuous extradural anaesthesia than in those who received general anaesthesia followed by narcotics in the period after operation. Furthermore, the capacity for activation of factor VIII was significantly lower after operation in the former group.

Fibrinolytic Inhibition With Tranexamic Acid Reduces Blood Loss and Blood Transfusion After Knee Arthroplasty

“…From our previous study and from other reports we found that factors such as the number of cemented components (Mylod et al 1990;Collins et al 1991;, plugging of the femoral canal (Raut, Stone and Wroblewski 1993) and method of anaesthesia (Modig et al 1983;Modig and Karlström 1987) could all influence blood loss in orthopaedic operations. Carlin et al (1980) consider that the administration of dextran decreases postoperative fibrinolytic inhibition after total hip arthroplasty, a finding which has potential influence on our results.…”

Activation of cascade systems by hip arthroplasty: No difference between fixation with and without cement

“…Epidural analgesia (EDA) lowers the incidence of postoperative thrombosis (Modig et al 1981) and attenuates the Factor VIII-complex response to surgical stress (Modig et al 1983, Bredbacka et al 1986). …”

Tranexamic Acid Reduces Allogenic Transfusion in Revision Hip Arthroplasty

“…The preoperative hemoglobin concentration is a strong predictor of perioperative transfusion and is often used to discriminate between patients at higher and lower risk for transfusion [3,11,24]. Several other factors reportedly influence perioperative blood loss in patients undergoing hip arthroplasty including gender, age, physical status of the patient, hypertension, body mass index, coagulation factors, type of anesthesia, and surgical procedure [1,7,8,13,19,21,25,26]. Walsh et al [27] reviewed 1035 cases of THA and reported the most important and consistent predictors of the requirement for a blood transfusion was advanced age and the use of low molecular weight heparin for DVT prophylaxis.…”