Consensus of the Orthopedic Anesthesia, Pain, and Rehabilitation Society on the use of peripheral nerve blocks in patients receiving thromboprophylaxis.
Evidence supports the concept that patients undergoing major orthopedic surgery benefit from either thromboprophylaxis or peripheral nerve blocks, especially continuous techniques. A group of anesthesiologists with significant experience in orthopedic anesthesia and peripheral nerve blocks reviewed the literature related to thromboprophylaxis and peripheral nerve blocks and their combination in orthopedics. Major bleeding, including retroperitoneal hematoma, is an established complication of thromboprophylaxis. Major bleeding, including retroperitoneal hematoma, is also an established complication of peripheral nerve blocks. Between 1997 and 2012, only 4 case reports of major bleeding were reported in patients receiving thromboprophylaxis and peripheral nerve blocks. Evidence supports the safety of the combination of thromboprophylaxis and peripheral nerve blocks. This group of experts concluded that currently there is no evidence that the combination of thromboprophylaxis and peripheral nerve block increases the risk of major bleeding compared to either of the treatments alone.
Department of Anesthesiology, University of Pittsburgh Medical Center (UPMC) Presbyterian-Shadyside Hospital, Pittsburgh, PA 15232, USA. Electronic address: chelje@anes.upmc.edu.
Jacques E
JE
Chelly
Department of Anesthesiology and Peri-Operative Medicine, University of Louisville, Louisville, KY 40202, USA.
Laura D
LD
Clark
Department of Anesthesiology, Perioperative Medicine, and Pain Management, University of Miami Health System, Miami, FL 33136, USA.
Ralf E
RE
Gebhard
Department of Anesthesia, University of Iowa Hospitals and Healthcare, Iowa City, IA 52242, USA.
Robert M
RM
Raw
Department of Anesthesiology, New York University School of Medicine, New York, NY 10016, USA.
Arthur
A
Atchabahian
D000925:Anticoagulants / Q000009:adverse effects* / Q000627:therapeutic use; D006406:Hematoma / Q000139:chemically induced; D006801:Humans; D009407:Nerve Block / Q000009:adverse effects* / Q000379:methods; D019637:Orthopedic Procedures / Q000379:methods*; D010146:Pain / Q000517:prevention & control; D010525:Peripheral Nerves / Q000187:drug effects*; D012955:Societies, Medical; D013927:Thrombosis / Q000517:prevention & control*
D000925:Anticoagulants
Major bleeding; Orthopedic anesthesia; Peripheral nerve block; Retroperitoneal hematoma; Thromboprophylaxis