Continuous Lumbar Plexus Catheter Removal in Postoperative Total Hip Replacement Patients Receiving Warfarin Thromboprophylaxis: A Retrospective Analysis  

作　　者：Joseph Marino Jay Curtin Carol Patrick Kara Theal Cristina Sison George Koutsouras Scott Alpert W. Healy III Oonagh Dowling Renee Pekmezaris J. E. Chelly 

机构地区：[1]Biostatistics Unit, The Feinstein Institute for Medical Research, Manhasset, USA [2]Biostatistics Unit, The Feinstein Institute for Medical Research, Manhasset, USA [3]Department of Anesthesiology, Franklin Hospital Medical Center, Valley Stream, USA [4]Department of Anesthesiology, Huntington Hospital, Huntington, USA [5]Department of Cardiology, Huntington Hospital, Huntington, USA [6]Department of Information Services, Huntington Hospital, Huntington, USA [7]Department of Orthopedic Anesthesia and Acute Interventional Pain, University of Pittsburgh School of Medicine, Pittsburgh, USA [8]Department of Orthopedics, Huntington Hospital, Huntington, USA [9]Department of Population Health, North Shore LIJ Health System, Great Neck, USA [10]Department of Population Health, North Shore LIJ Health System, Great Neck, USA

出　　处：《Open Journal of Anesthesiology》2013年第6期293-297,共5页麻醉学期刊（英文）

摘　　要：Background and Objectives: Based on the case reports of hemorrhagic complications, recommendations for the removal of lumbar plexus catheters in anticoagulated patients were created. These guidelines are controversial as they limit the use of lumbar plexus blocks in postoperative anticoagulated patients. This study was designed to evaluate the incidence of hemorrhagic complications and coagulation status using International Normalized Ratio (INR) at the time of lumbar plexus catheter removal in patients receiving warfarin after total hip replacement. Methods: A retrospective study of 371 patients on warfarin thromboprophylaxis who received continuous lumbar plexus catheters for postoperative analgesia after total hip surgery was performed. The primary outcome measure was the incidence of bleeding complications after catheter removal;secondary outcome measures included warfarin dose, bridge therapy, incidence of deep vein thrombosis, pulmonary embolism (DVT/PE) and INR values upon catheter removal. Results: Almost all lumbar plexus catheters (93%;344/371) were removed at 72 hours. At the time of catheter removal, mean INR was 1.99 [1.42-2.41] (p = 0.015);67% of patients had an INR > 1.5 and half of these patients had INRs between 2.0-3.0;5% had INR’s between 3.0-4.0. There were no adverse bleeding complications or nerve injury after the removal of catheters. Conclusions: We observed no incidence of bleeding after lumbar plexus catheter removal despite 67 % of patients demonstrating INR’s > 1.5. Our retrospective analysis illustrates the relative safety of catheter removal in anticoagulated patients and suggests that the removal of lumbar plexus catheters can be safely performed with an INR > 1.5 in patients receiving warfarin.Background and Objectives: Based on the case reports of hemorrhagic complications, recommendations for the removal of lumbar plexus catheters in anticoagulated patients were created. These guidelines are controversial as they limit the use of lumbar plexus blocks in postoperative anticoagulated patients. This study was designed to evaluate the incidence of hemorrhagic complications and coagulation status using International Normalized Ratio (INR) at the time of lumbar plexus catheter removal in patients receiving warfarin after total hip replacement. Methods: A retrospective study of 371 patients on warfarin thromboprophylaxis who received continuous lumbar plexus catheters for postoperative analgesia after total hip surgery was performed. The primary outcome measure was the incidence of bleeding complications after catheter removal;secondary outcome measures included warfarin dose, bridge therapy, incidence of deep vein thrombosis, pulmonary embolism (DVT/PE) and INR values upon catheter removal. Results: Almost all lumbar plexus catheters (93%;344/371) were removed at 72 hours. At the time of catheter removal, mean INR was 1.99 [1.42-2.41] (p = 0.015);67% of patients had an INR > 1.5 and half of these patients had INRs between 2.0-3.0;5% had INR’s between 3.0-4.0. There were no adverse bleeding complications or nerve injury after the removal of catheters. Conclusions: We observed no incidence of bleeding after lumbar plexus catheter removal despite 67 % of patients demonstrating INR’s > 1.5. Our retrospective analysis illustrates the relative safety of catheter removal in anticoagulated patients and suggests that the removal of lumbar plexus catheters can be safely performed with an INR > 1.5 in patients receiving warfarin.

关 键 词：Lumbar PLEXUS Block WARFARIN PROPHYLAXIS Deep Vein Thrombosis Pulmonary EMBOLISM 

分 类 号：R5[医药卫生—内科学]