Objectives
The American Society of Regional Anesthesia and Pain Medicine's guidelines recommend
a 1-hour interval after neuraxial anesthesia (NA) before systemic heparinization to
mitigate the risk of spinal hematoma (SH). The study authors aimed to characterize
the time interval between NA and systemic heparinization in vascular surgery patients
(primary outcome). The secondary outcomes included the historic incidence of SH, and
risk estimation of the SH formation based on available data. Heparin dose, length
of surgery, difficulty and/or the number of NA attempts, and patient demographics
were recorded.
Design
A retrospective analysis between April 2012 and April 2022.
Setting
A single (academic) center.
Participants
Vascular surgery patients.
Interventions
Intravenous heparin administration.
Measurements and Main Results
All (N = 311) vascular patients were reviewed, of whom 127 (5 femoral-femoral bypass,
67 femoral-popliteal bypass, and 55 endovascular aneurysm repairs [EVAR]) received
NA and were included in the final analysis. Patients receiving general anesthesia
alone (N = 184) were excluded. Neuraxial anesthesia included spinal (N = 119), epidural
(N = 4), or combined spinal-epidural (N = 4) blocks. The average time between NA and
heparin administration was 42.8 ± 22.1 minutes, with 83.7% of patients receiving heparin
within 1 hour of NA. The time between NA and heparin administration was 40.4 ± 22.3,
50.1 ± 23.4, and 31.3 ± 12.5 minutes for femoral-femoral bypass, femoral-popliteal
bypass, and EVAR, respectively. Heparin was administered after 1 hour of NA in 20%
of femoral-femoral bypass, 27% of femoral-popliteal bypass, and 3.9% of EVAR patients.
No SHs were reported during the study period.
Conclusions
The vast majority of vascular surgery patients at the authors’ center received heparin
within 1 hour of NA. Further studies are required to assess if their findings are
consistent in other vascular surgery settings and/or centers.
Key Words
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References
- Regional anaesthesia and outcomes.BJA Educ. 2018; 18: 52-56
- Does regional anaesthesia really improve outcome?.Br J Anaesth. 2011; 107: i90-i95
- Complications and controversies of regional anaesthesia: A review.Indian J Anaesth. 2009; 53: 543-553
- Current issues in spinal anesthesia.Anesthesiology. 2001; 94: 888-906
- Failed epidural: Causes and management.Br J Anaesth. 2012; 109: 144-154
- Regional anesthesia in the patient receiving antithrombotic or thrombolytic therapy: American Society of Regional Anesthesia and Pain Medicine Evidence-Based Guidelines (Fourth Edition).Reg Anesth Pain Med. 2018; 43: 263-309
- Complications of lumbar puncture followed by anticoagulation.Stroke. 1981; 12: 879-881
- Estimating the risk of a rare but plausible complication that has not occurred after n trials.Anesth Analg. 2018; 127: 1259-1263
- Association of lumbar puncture with spinal hematoma in patients with and without coagulopathy.JAMA. 2020; 324: 1419
- Locoregional anesthesia for endovascular aneurysm repair.J Vasc Surg. 2012; 56: 510-519
- Neuraxial and combined neuraxial/general anesthesia compared to general anesthesia for major truncal and lower limb surgery.Anesth Analg. 2017; 125: 1931-1945
Article info
Publication history
Published online: December 17, 2022
Publication stage
In Press Corrected ProofFootnotes
Support was provided solely by departmental and institutional resources.
Identification
Copyright
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