Lower thrombosis risk with epidural blockade in knee arthroplasty

Nielsen, Poul; Jørgensen, Lars Nannestad; Albrecht‐Beste, Elisabeth; Leffers, Anne-Mette; Rasmussen, Lars S.

doi:10.3109/17453679008993060

Cited by 45 publications

(16 citation statements)

References 14 publications

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“…The type of anesthesia used is certainly one of the most frequently evaluated topics in the literature, although some doubts remain regarding the effects of anesthesia type on DVT incidence. Researchers have studied epidural block alone versus general anesthesia, and most data suggest that epidural block should be protective against DVT (29,37)–(40). However, in a recent article, Macfarlane et al (41) questioned these results.…”

Section: Discussionmentioning

confidence: 99%

The influence of tourniquet use and operative time on the incidence of deep vein thrombosis in total knee arthroplasty

Hernandez¹,

Almeida²,

Fávaro³

et al. 2012

Clinics

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OBJECTIVE:To evaluate the association between tourniquet and total operative time during total knee arthroplasty and the occurrence of deep vein thrombosis.METHODS:Seventy-eight consecutive patients from our institution underwent cemented total knee arthroplasty for degenerative knee disorders. The pneumatic tourniquet time and total operative time were recorded in minutes. Four categories were established for total tourniquet time: <60, 61 to 90, 91 to 120, and >120 minutes. Three categories were defined for operative time: <120, 121 to 150, and >150 minutes. Between 7 and 12 days after surgery, the patients underwent ascending venography to evaluate the presence of distal or proximal deep vein thrombosis. We evaluated the association between the tourniquet time and total operative time and the occurrence of deep vein thrombosis after total knee arthroplasty.RESULTS:In total, 33 cases (42.3%) were positive for deep vein thrombosis; 13 (16.7%) cases involved the proximal type. We found no statistically significant difference in tourniquet time or operative time between patients with or without deep vein thrombosis. We did observe a higher frequency of proximal deep vein thrombosis in patients who underwent surgery lasting longer than 120 minutes. The mean total operative time was also higher in patients with proximal deep vein thrombosis. The tourniquet time did not significantly differ in these patients.CONCLUSION:We concluded that surgery lasting longer than 120 minutes increases the risk of proximal deep vein thrombosis.

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Section: Discussionmentioning

confidence: 99%

The influence of tourniquet use and operative time on the incidence of deep vein thrombosis in total knee arthroplasty

Hernandez¹,

Almeida²,

Fávaro³

et al. 2012

Clinics

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“…[38][39][40][41] Compliance may limit their use. 42 Regional anaesthesia confers a modest benefit, [43][44][45][46] probably by increasing venous blood flow and promoting fibrinolysis. There are no data to support the use of graduated compression stockings after TKR.…”

Section: Discussionmentioning

confidence: 99%

A randomised comparison of a foot pump and low-molecular-weight heparin in the prevention of deep-vein thrombosis after total knee replacement

Warwick

Harrison

Whitehouse³

et al. 2002

The Journal of Bone and Joint Surgery

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Patients who undergo total knee replacement (TKR) are at high risk of venous thromboembolism. Low-molecular-weight heparins (LMWH) are the most suitable chemical prophylactic agents but there are some uncertainties about their safety and effectiveness. The foot pump offers an alternative. We randomised 229 patients undergoing primary, unilateral TKR to receive either the A-V Impulse foot pump or enoxaparin, a LMWH. Ascending venography was undertaken between the sixth and eighth postoperative day in 188 patients without knowledge of the randomisation category. The prevalence of venographic deep-vein thrombosis was 58% (57/99) in the foot-pump group and 54% (48/89) in the LMWH group which was not statistically significant. There were four cases of proximal thrombi and two of fatal pulmonary emboli in the foot-pump group and none in the LMWH group. There were fewer haemorrhagic complications and soft-tissue effects in the foot-pump group. We conclude that the neither method provides superior prophylaxis.

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“…In elective hip and knee arthroplasties, regional anesthesia has been shown to reduce the incidence of DVT compared with general anesthesia (Modig 1985, Nielsen et al 1990). The role of anesthesia in arthroscopic knee surgery in reducing DVT is unclear because to our knowledge no studies have yet addressed this problem.…”

Section: Discussionmentioning

confidence: 99%

Thromboembolic complications after arthroscopic knee surgery: Incidence and risk factors in 101 patients

Schippinger

Wirnsberger

Obernosterer

et al. 1998

Acta Orthopaedica Scandinavica

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Lower thrombosis risk with epidural blockade in knee arthroplasty

Cited by 45 publications

References 14 publications

The influence of tourniquet use and operative time on the incidence of deep vein thrombosis in total knee arthroplasty

The influence of tourniquet use and operative time on the incidence of deep vein thrombosis in total knee arthroplasty

A randomised comparison of a foot pump and low-molecular-weight heparin in the prevention of deep-vein thrombosis after total knee replacement

Thromboembolic complications after arthroscopic knee surgery: Incidence and risk factors in 101 patients

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