Nordic guidelines for neuraxial blocks in disturbed haemostasis from the Scandinavian Society of Anaesthesiology and Intensive Care Medicine.
Cast your vote
You can rate an item by clicking the amount of stars they wish to award to this item.
When enough users have cast their vote on this item, the average rating will also be shown.
Your vote was cast
Thank you for your feedback
Thank you for your feedback
MetadataShow full item record
CitationActa Anaesthesiol Scand. 2010, 54(1):16-41
AbstractBACKGROUND: Central neuraxial blocks (CNBs) for surgery and analgesia are an important part of anaesthesia practice in the Nordic countries. More active thromboprophylaxis with potent antihaemostatic drugs has increased the risk of bleeding into the spinal canal. National guidelines for minimizing this risk in patients who benefit from such blocks vary in their recommendations for safe practice. METHODS: The Scandinavian Society of Anaesthesiology and Intensive Care Medicine (SSAI) appointed a task force of experts to establish a Nordic consensus on recommendations for best clinical practice in providing effective and safe CNBs in patients with an increased risk of bleeding. We performed a literature search and expert evaluation of evidence for (1) the possible benefits of CNBs on the outcome of anaesthesia and surgery, for (2) risks of spinal bleeding from hereditary and acquired bleeding disorders and antihaemostatic drugs used in surgical patients for thromboprophylaxis, for (3) risk evaluation in published case reports, and for (4) recommendations in published national guidelines. Proposals from the taskforce were available for feedback on the SSAI web-page during the summer of 2008. RESULTS: Neuraxial blocks can improve comfort and reduce morbidity (strong evidence) and mortality (moderate evidence) after surgical procedures. Haemostatic disorders, antihaemostatic drugs, anatomical abnormalities of the spine and spinal blood vessels, elderly patients, and renal and hepatic impairment are risk factors for spinal bleeding (strong evidence). Published national guidelines are mainly based on experts' opinions (weak evidence). The task force reached a consensus on Nordic guidelines, mainly based on our experts' opinions, but we acknowledge different practices in heparinization during vascular surgery and peri-operative administration of non-steroidal anti-inflammatory drugs during neuraxial blocks. CONCLUSIONS: Experts from the five Nordic countries offer consensus recommendations for safe clinical practice of neuraxial blocks and how to minimize the risks of serious complications from spinal bleeding. A brief version of the recommendations is available on http://www.ssai.info.
DescriptionTo access publisher full text version of this article. Please click on the hyperlink in Additional Links field
- Reducing risk of spinal haematoma from spinal and epidural pain procedures.
- Authors: Breivik H, Norum H, Fenger-Eriksen C, Alahuhta S, Vigfússon G, Thomas O, Lagerkranser M
- Issue date: 2018 Apr 25
- Scandinavian guidelines for neuraxial block and disturbed haemostasis: replacing wishful thinking with evidence based caution.
- Authors: Moen V
- Issue date: 2010 Jan
- Managing anticoagulated patients during neuraxial anaesthesia.
- Authors: Green L, Machin SJ
- Issue date: 2010 Apr
- [Regional analgesia--risks and benefits].
- Authors: Breivik H, Norum HM
- Issue date: 2010 Feb 25
- [Clinical guidelines for inhibitors of hemostasis and locoregional neuraxial anesthesia. Spanish Society of Anesthesiology-Resuscitation and Pain Therapy, Division of Hemostasis, Transfusion Medicine, and Perioperative Fluid Therapy].
- Authors: Sociedad Española de Anestesiología-Reanimación y Terapéutica del Dolor, Sección de Hemostasia, Medicina Transfusional y Fluidoterapia Perioperatoria.
- Issue date: 2005 Aug-Sep