Regional Anaesthesia in Patients At Risk of Bleeding
Presenter : Dr Elis
Supervisor : Professor Carol
OBJECTIVE
- Outline the risks of neuraxial and peripheral nerve blocks in a patient who is anticoagulated.
- Specify the classes of anticoagulant drugs, their key mechanisms of action and the available reversal agents.
- Discuss principles guiding risk/benefit decisions before performing peripheral nerve blocks in patients who are anticoagulated.
- Discuss recent guidelines by Association of Anaesthetists (AoA) in the UK and the American Society of Regional Anesthesia (ASRA)
- time intervals after stopping anticoagulant medications at which it is appropriate to perform CNB
- time intervals at which the drugs can be restarted after the procedure or removal of an epidural catheter.
LEARNING POINTS
- Always consider
- Likelihood and consequences of hemorrhagic complications
- Compressibility of the site
- Risk/benefit with stopping patient’s anticoagulation meds and risks of GA
DISCUSSION
- Vertebral canal haematoma (VCH) is a rare complication of neuraxial anaesthesia.
- Higher risk in anticoagulated patients
- Major bleeding in peripheral nerve blocks can also have serious sequelae
- Guidelines set out recommended time intervals between stopping anticoagulants and performing neuraxial anaesthesia.
- Separate guidelines exist for patients with acute hip fractures, patients who are pregnant, and patients with chronic pain.