Effects of pudendal nerve, epidural and subarachnoid block on coagulation of pregnant women.
OBJECTIVE
The significant reduction in postoperative thromboembolic complications has been attributed to the use of regional block, probably due to attenuation of the neuroendocrine-metabolic response. Pregnant women, who demonstrate important hypercoagulability, can in theory benefit from this effect during labor. The objective of this study was to determine the effects of regional block on coagulation of pregnant women.


METHODS
Thirty patients in the 3rd trimester were enrolled; ten patients underwent epidural block for cesarean section with 150 mg of 0.5% bupivacaine without epinephrine and 2 mg of morphine (PD group); ten underwent subarachnoid block for cesarean section with 15 mg of 0.5% hyperbaric bupivacaine and 0.2 mg of morphine (SA group); and ten, pudendal block for vaginal delivery with up to 100 mg of 0.5% bupivacaine without epinephrine (BP group). Coagulation tests (prothrombin time, thrombin time, activated partial thromboplastin time) and thromboelastography (r-time, k-time, r+k-time, alpha-angle, maximum amplitude) were performed in the following moments: before and after the blockade, after delivery, and 24 hours after the blockade in PD and SA groups. In the BP group, the evaluation was done before the blockade, after delivery, and 24 hours after the blockade.


RESULTS
The results indicate that the anesthetic technique did not influence coagulation of pregnant women. They also demonstrate that coagulation is activated during labor, which is responsible for the changes seen in all the study groups.


CONCLUSIONS
In the conditions of the present study, the sympathetic blockade and the local anesthetic did not have any influence on the coagulation of pregnant women at term undergoing epidural, subarachnoid, or pudendal nerve block.
Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HC-FMUSP), São Paulo, SP.
Alberto
A
Vasconcelos
Lígia Andrade Silva Telles
LA
Mathias
D000328:Adult; D000767:Anesthesia, Epidural; D000773:Anesthesia, Obstetrical; D001777:Blood Coagulation; D002585:Cesarean Section; D005260:Female; D006801:Humans; D009407:Nerve Block; D011247:Pregnancy; D013346:Subarachnoid Space