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Neuraxial Anesthesia and Low-Molecular-Weight Heparin Prophylaxis in Major Orthopedic Surgery in the Wake of the Latest American Society of Regional Anesthesia Guidelines

Rowlingson, John C. MD*; Hanson, Peter B. MD†

Section Editor(s): Horlocker, Terese T.

doi: 10.1213/01.ANE.0000148683.54686.0F
Regional Anesthesia: Research Report
Chinese Language Editions

In May 2003, the Second American Society of Regional Anesthesia Consensus Conference statement was issued partly in response to continued safety concerns over the use of regional anesthesia—in particular, neuraxial techniques—with low-molecular-weight heparin (LMWH) prophylaxis in major orthopedic surgery. As the 2003 Consensus statement makes clear, regional anesthesia may be used safely with LMWH prophylaxis. The key to optimizing patient safety, however, depends on a careful calibration of the total daily dose and the timing of the first and subsequent doses of the LMWH drug with the timing and management of the regional anesthetic procedure. Because the challenge of successfully providing regional anesthesia in the presence of LMWH thromboprophylaxis is a clinical one, anesthesiologists should do what they can to ensure that every member of the surgical team has an understanding of current literature and practice guidelines such as those recently published by the American Society of Regional Anesthesia.

IMPLICATIONS: Spinal hematoma, although a rare complication, remains a concern of clinicians contemplating the use of regional anesthesia with low-molecular-weight heparin, one of the class of drugs indicated for preventing blood clots during orthopedic surgery. This article reviews the latest practice guidelines to show how this combination treatment can be used safely and reflects a specific clinical application.

*Department of Anesthesiology, University of Virginia, Charlottesville, Virginia; and the †Department of Orthopedics, Sharp Grossmont Hospital, LaMesa, California

This article was developed from a first draft written by Fred Balzac of Chase Medical Communications, Inc., Wilton, CT, who also assisted the authors with editing and revising subsequent drafts. All editorial work provided by Chase Medical Communications was funded with an unrestricted educational grant by Pfizer Inc., which also provided an honorarium to the authors.

Accepted for publication October 8, 2004.

Address correspondence and reprint requests to John C. Rowlingson, MD, UVA Health System, PO Box 800710, Charlottesville, VA 22908-0710. Address e-mail to

© 2005 International Anesthesia Research Society