Epidural analgesia? A prospective analysis of perioperative coagulation in cytoreductive surgery and hyperthermic intraperitoneal chemotherapy - 16/04/19
Abstract |
Background |
Cytoreductive surgery (CRS) and heated intraperitoneal chemotherapy (HIPEC) is beneficial in peritoneal carcinomatosis. Epidurals provide excellent pain relief for laparotomies. Coagulopathy (platelet count <100 × 109/L, INR>1.5 or PTT >45) occurs with CRS and HIPEC, increasing risk for bleeding complications with epidurals. This prospective study characterizes clot kinetics with thromboelastography (TEG) to determine suitability for epidural analgesia.
Methods |
After Research Ethics approval, thirty consented patients had blood collected. Primary data collected included TEG and conventional coagulation measures (platelets, PTT and INR). Secondary data collected included demographics, disease, surgical, intraoperative factors and complications from epidural placement.
Results |
Of 30 patients analyzed, two had incomplete data. Four developed abnormal coagulation between the second and fifth post-operative day. For all patients, TEG values remained normal. Postoperative INR was elevated until day 3 (all INR < 1.5). 17 patients received epidural analgesia, 3 demonstrated abnormal conventional coagulopathic criteria despite normal TEG.
Conclusions |
In this study CRS and HIPEC do not contribute to the conventional definition of clinical coagulopathy. Clot kinetics indicate that epidural catheters may be recommended for post-operative analgesia.
El texto completo de este artículo está disponible en PDF.Highlights |
• | In CRS and HIPEC coagulation derangements is rarely of clinical significance. |
• | Whole clot kinetics by TEG™ show no significant coagulopathy, compared to baseline. |
• | Analgesia is challenging but clot kinetics suggest epidurals may be recommended. |
Esquema
Vol 217 - N° 5
P. 887-892 - mai 2019 Regresar al númeroBienvenido a EM-consulte, la referencia de los profesionales de la salud.
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