التفاصيل البيبلوغرافية
| العنوان: |
Reducing risk of spinal haematoma from spinal and epidural pain procedures |
| المؤلفون: |
Breivik, H. (Harald), Norum, H. (Hilde), Fenger-Eriksen, C. (Christian), Alahuhta, S. (Seppo), Vigfússon, G. (Gísli), Thomas, O. (Owain), Lagerkranser, M. (Michael) |
| بيانات النشر: |
De Gruyter |
| سنة النشر: |
2018 |
| المجموعة: |
Jultika - University of Oulu repository / Oulun yliopiston julkaisuarkisto |
| مصطلحات موضوعية: |
anticoagulants, epidural analgesia, platelet inhibitors, postoperative complications, practise advisory, spinal analgesia, spinal haematoma |
| الوصف: |
Background and aims: Central neuraxial blocks (CNB: epidural, spinal and their combinations) and other spinal pain procedures can cause serious harm to the spinal cord in patients on antihaemostatic drugs or who have other risk-factors for bleeding in the spinal canal. The purpose of this narrative review is to provide a practise advisory on how to reduce risk of spinal cord injury from spinal haematoma (SH) during CNBs and other spinal pain procedures. Scandinavian guidelines from 2010 are part of the background for this practise advisory. Methods: We searched recent guidelines, PubMed (MEDLINE), SCOPUS and EMBASE for new and relevant randomised controlled trials (RCT), case-reports and original articles concerning benefits of neuraxial blocks, risks of SH due to anti-haemostatic drugs, patient-related risk factors, especially renal impairment with delayed excretion of antihaemostatic drugs, and specific risk factors related to the neuraxial pain procedures. Results and recommendations: Epidural and spinal analgesic techniques, as well as their combination provide superior analgesia and reduce the risk of postoperative and obstetric morbidity and mortality. Spinal pain procedure can be highly effective for cancer patients, less so for chronic non-cancer patients. We did not identify any RCT with SH as outcome. We evaluated risks and recommend precautions for SH when patients are treated with antiplatelet, anticoagulant, or fibrinolytic drugs, when patients’ comorbidities may increase risks, and when procedure-specific risk factors are present. Inserting and withdrawing epidural catheters appear to have similar risks for initiating a SH. Invasive neuraxial pain procedures, e.g. spinal cord stimulation, have higher risks of bleeding than traditional neuraxial blocks. We recommend robust monitoring routines and treatment protocol to ensure early diagnosis and effective treatment of SH should this rare but potentially serious complication occur. Conclusions: When neuraxial analgesia is considered for a ... |
| نوع الوثيقة: |
article in journal/newspaper |
| وصف الملف: |
application/pdf |
| اللغة: |
English |
| Relation: |
info:eu-repo/semantics/altIdentifier/pissn/1877-8860; info:eu-repo/semantics/altIdentifier/eissn/1877-8879 |
| الاتاحة: |
http://urn.fi/urn:nbn:fi-fe2018080733447 |
| Rights: |
info:eu-repo/semantics/openAccess ; ©2018 Harald Breivik et al., published by De Gruyter, Berlin/Boston. This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 License. ; https://creativecommons.org/licenses/by-nc-nd/4.0/ |
| رقم الانضمام: |
edsbas.70C74EC5 |
| قاعدة البيانات: |
BASE |