Regional anaesthesia and antithrombotic agents: recommendations of the European Society of Anaesthesiology

Abstract

in order to minimise bleeding complications during regional anaesthetic techniques, care should be taken to avoid traumatic puncture. If a bloody tap occurs when intraoperative anticoagulation is planned, postponing surgery should be considered. Alternatively, catheters can be placed the night before surgery. Regional anaesthesia in patients receiving full anticoagulation treatment continues to be contraindicated. Catheter manipulation and removal carry similar risks to insertion and the same criteria should apply. Appropriate neurological monitoring is essential during the postoperative recovery period and following catheter removal. The final decision to perform regional anaesthesia in patients receiving drugs that affect haemostasis has to be taken after careful assessment of individual risks and benefits.

Thromboelastography (TEG®) demonstrates that tinzaparin 4500 international units has no detectable anticoagulant activity after caesarean section

“…In order to 84 reduce the risk of haematoma development, current UK and international consensus 85 guidelines recommend that performance of a neuraxial block or removal of an epidural 86 catheter should not be carried out until 10-12 h after a thromboprophylactic dose of 87 LMWH. 5,6,7 These guidelines were devised for use in non-pregnant patients, but have been 88 extrapolated for use in the pregnant population as well, even though these women are known 89 to be hypercoagulable. the effect of LMWH.…”

Regionalanästhesie: traditio et innovatio

“…Antikoagulation [18]. [19,20]. Die Analyse großer Patientenkollektive zeigte die tatsächlichen Risiken bei neuroaxialen Blockaden, insbesondere bei der Anwendung von Epiduralkathetern in bestimmten Patientenkollektiven [21][22][23].…”

“…Namen wie Karl Koller, 1884 Entdecker des Kokains als Lokalanästheti-kum, und August Bier, Erstbeschreiber der klinisch nutzbaren Spinalanästhesie im Jahr 1898, waren Pioniere ihrer Zeit, ermöglichten sie doch, dass Operationen auch ohne Bewusstseinsverlust schmerzfrei durchgeführt werden konnten [1,2]. Mit der zunehmenden Kenntnis der topografischen und funktionellen Anatomie der peripheren Nerven war der Beginn des 20 …”

Prevention of venous thromboembolism in the Enhanced Recovery After Surgery (ERAS) setting: an evidence-based review

“…Guidelines exist for the management of patients on anticoagulant drugs who have indwelling neuraxial catheters. 20,21 Neuraxial hematoma is a rare but serious complication of spinal or epidural procedures. For patients receiving postoperative epidural analgesia, antithrombotic agents should be used cautiously.…”