RESUMEN
The benefit/risk ratio of administering heparin during spinal anaesthesia in patients undergoing total hip replacement (THR) has not been studied widely. We conducted a prospective, randomized, double-blind study to compare low molecular weight heparin (LMWH) for 10 days and placebo in patients undergoing THR performed under spinal anaesthesia associated with gradual compression stockings. Efficacy was assessed by systematic bilateral ascending venography on day 10 +/- 2 in a sequential analysis. Among the 170 patients enrolled, data were available in 153 patients. In the LMWH group (n = 78) the total incidence of deep vein thrombosis (DVT) was 14.1% compared with 37.3% in the placebo group (n = 75) (P = 0.0016). No gross neurological sequelae were observed during the study. This study showed that the addition of LMWH in patients undergoing THR under spinal anaesthesia and wearing gradual compression stockings significantly decreased the incidence of venogram-proved DVT.
Asunto(s)
Anestesia Raquidea , Anticoagulantes/uso terapéutico , Vendajes , Heparina de Bajo-Peso-Molecular/uso terapéutico , Prótesis de Cadera , Adulto , Anciano , Anciano de 80 o más Años , Terapia Combinada , Método Doble Ciego , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/prevención & control , Hemorragia Posoperatoria/prevención & control , Estudios Prospectivos , Tromboembolia/prevención & controlAsunto(s)
Anestesia Epidural , Anestesia Raquidea , Enoxaparina , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Enoxaparina/administración & dosificación , Enoxaparina/uso terapéutico , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Factores de Riesgo , Seguridad , Tromboflebitis/prevención & controlRESUMEN
OBJECTIVE: To determine whether leaving an intrathecal catheter in place in the postoperative period prevents postdural puncture headache (PDPH). METHODS: Lumbar puncture was performed with an 18-gauge Tuohy needle. 0.5% bupivacaine spinal anesthesia was given through a 20-gauge catheter in 87 patients having orthopedic surgery. Postoperatively, patients were allocated randomly to have the catheter immediately withdrawn (group 1, N = 47) or kept in place for 12 to 24 hours (group 2, N = 40). Patients were questioned by a blinded observer, about PDPH twice a day on postoperative days 1, 2, 3, and 8. RESULTS: The incidence of PDPH was 9.2%, and this was comparable in the two groups (5 patients in group 1 and 3 patients in group 2). CONCLUSION: Leaving the intrathecal catheter in place in the postoperative period for 12 to 24 hours does not prevent PDPH.