The Effect of Different Anaesthetic Techniques on the Incidence of Thrombosis following Total Hip Replacement

Abstract

SummaryWe performed a retrospective analysis on the influence of three types of anaesthesia on the incidence of deep vein thrombosis (DVT) following total hip replacement (THR) in consecutive patients randomized to either the low molecular weight heparinoid Otg 10172 (97 patients), of placebo (99 patients). Ninety patients were operated under epidural anaesthesia, 77 patients under psoas compartment block with additional inhalation anaesthesia, and 29 patients under general anaesthesia. DVT assessment was performed by bilateral venography between days 8 and 12 postoperatively. The overall incidence of DVT in the 196 patients was 37% in the epidural anaesthasia group, 35% in the psoas compartment block group, and 36% in the general anaesthesia group. Although the incidence of DVT in patients randomuedto placebo was similar in the two anaesthesia groups (53%), there was an important reduction of the occurrence of proximal DVT by the heparinoid in the psoas compartment block group (from 20 to 0%), compared to the epidural anaesthesia group (from 27 to l8%) (p <0.0061). Significant y more minor wound hematomas occurred in the psoas compartment block group as compared to the epidural anaesthesia group (p <0.05). Synergrsm of thrombin generation inhibition by the heparinoid and inhibition of plateletlggregation at the damaged vessel wall, by high local concentrations of bupivacaine in the psoas compartment block technique, is proposed as a possible mechanism behind this observation.

Hüfttotalendoprothesen - Besonderheiten aus anästhesiologischer Sicht

“…Für die Durchführung von Operationen am Hüftgelenk sind grundsätzlich regionale Verfahren ebenso wie Allgemeinnarkosen geeignet. Gleichwohl haben die unterschiedlichen Verfahren spezifische Vor-und Nachteile (12,13,21,23,33,46,(50)(51)(52)67,97,99,109,110,112,113), die in Tab. 3 zusarnrnengefaßt werden.…”

“…1 werden die in der Literatur unterschiedlich beurteilten thrombosefördernden und -protektiven Faktoren dargestellt.Hoek u.Mitarb. sehen keine thromboserelevanten Unterschiede(46) bezüglich der Anwendung verschiedener Anästhesietechniken. Nach bilateraler Venographie zeigte sich bei einem Gesamtkollektiv von 196 untersuchten Patienten eine tiefe Beinvenenthrombose bei 37% der epiduralen Gruppe, bei 36% der Patienten, die in Allgemeinanästhesie operiert wurden und bei 35 % der Patienten, die für den Eingriff einen Psoaskompartmentblock, kombiniert mit Inhalationsanästhetika, erhielten.…”

Orgaran (Org 10172) or Heparin for Preventing Venous Thrombosis after Elective Surgery for Malignant Disease? A Double-Blind, Randomised, Multicentre Comparison

“…The situation differs in hip surgery where both Orgaran (34,35) and the LMW heparins (34) have generally yielded VT rates lower than those expected for low dose sc heparin and have not caused increased bleeding. Indeed, their preventive effect has been similar to that observed with adjusted dose sc heparin or warfarin (36).…”

Evaluation of the effects of levobupivacaine on clotting and fibrinolysis using thromboelastography

“…Lidocaine, bupivacaine and ropivacaine [4±9] decrease the rate of clot formation and the ultimate strength of the clot formed. The incidence of wound haematomas in patients who underwent a psoas block for total hip replacement was higher than in those who underwent epidural blockade or no regional technique [10]. There is some evidence that this effect is of clinical signi®cance.…”

“…There is some evidence that this effect is of clinical significance. The incidence of wound haematomas in patients who underwent a psoas block for total hip replacement was higher than in those who underwent epidural blockade or no regional technique [10]. Epidural infusions in patients undergoing vascular surgery prevented a rise in coagulability and improved outcome [10–14].…”