Seminars in Arthroplasty
Volume 20, Issue 4 , Pages 222-226 , December 2009

Intraoperative Techniques to Reduce Thromboembolism: Regional Anesthesia and Intraoperative Heparin

  • Nigel E. Sharrock, BMedSci, MB, ChB

      Affiliations

    • Corresponding Author InformationAddress reprint requests to Nigel E. Sharrock, BMedSci, MB, ChB, Department of Anesthesiology, Hospital for Special Surgery, Weill Cornell Medical College, 535 E 70th St, New York, NY 10021

References 

  1. Davis FM, Quince M, Laurenson VG. Deep vein thrombosis and anaesthetic technique in emergency hip surgery. BMJ. 1980;281:1528–1529
  2. Thorburn J, Louden JR, Vallance R. Spinal and general anaesthesia in total hip replacement: Frequency of deep vein thrombosis. Br J Anaesth. 1980;52:1117–1120
  3. Modig J, Borg T, Karlström G, et al. Thromboembolism after total hip replacement: Role of epidural and general anesthesia. Anesth Analg. 1983;62:174–180
  4. Sharrock NE, Haas SB, Hargett MJ, et al. Effects of epidural anesthesia on the incidence of deep-vein thrombosis after total knee arthroplasty. J Bone Joint Surg Am. 1991;73:502–506
  5. Williams-Russo P, Sharrock NE, Haas SB, et al. Randomized trial of epidural versus general anesthesia: Outcomes after primary total knee replacement. Clin Orthop. 1996;331:199–208
  6. Sharrock NE, Ranawat CS, Urquhart B, et al. Factors influencing deep vein thrombosis following total hip arthroplasty. Anesth Analg. 1993;76:765–771
  7. Lieberman JR, Huo MH, Hanway J, et al. The prevalence of deep venous thrombosis after total hip arthroplasty with hypotensive epidural anesthesia. J Bone Joint Surg Am. 1994;76:341–348
  8. Turpie AGG, Levine MN, Hirsh J, et al. A randomized controlled trial of low-molecular-weight heparin (enoxaparin) to prevent deep-vein thrombosis in patients undergoing elective hip surgery. N Engl J Med. 1986;315:925–929
  9. Eriksson BI, Kälebo P, Anthmyr BA, et al. Prevention of deep-vein thrombosis and pulmonary embolism after total hip replacement (Comparison of low-molecular-weight heparin and unfractionated heparin). J Bone Joint Surg [Am]. 1991;73:484–493
  10. Planes A, Vochelle N, Fagola M, et al. Efficacy and safety of a perioperative enoxaparin regimen in total hip replacement under various anesthesias. Am J Surg. 1991;161:525–531
  11. Eriksson BI, Ekman S, Baur M, et al. Regional block anaesthesia versus general anaesthesia (Are different antithrombotic drugs equally effective in patients undergoing hip replacement? Retrospective analysis of 2354 patients undergoing hip replacement receiving either recombinant hirudin, unfractionated heparin or enoxaparin). (abstract) Thromb Haemost. 1997;77(suppl):487;(PS-1992)
  12. Davis FM, McDermott E, Hickton C, et al. Influence of spinal and general anaesthesia on haemostasis during total hip arthroplasty. Br J Anaesth. 1987;59:561–571
  13. Sharrock NE, Go G, Mineo R, et al. The hemodynamic and fibrinolytic response to low dose epinephrine and phenylephrine infusions during total hip replacement under epidural anesthesia. Thromb Haemost. 1992;68:436–441
  14. Niemi TT, Pitkanen M, Syrjala M, et al. Comparison of hypotensive epidural anaesthesia and spinal anaesthesia on blood loss and coagulation during and after total hip arthroplasty. Acta Anaesthesiol Scand. 2000;44:457–464
  15. Wright C, Cousins M. Blood flow distribution in the human leg following epidural sympathetic blockade. Arch Surg. 1972;105:334–337
  16. Bading B, Blank S, Sculco TP, et al. Augmentation of calf blood flow by epinephrine infusion during lumbar epidural anesthesia. Anesth Analg. 1994;78:1119–1124
  17. Macaulay W, Westrich G, Sharrock N, et al. Effect of pneumatic compression on fibrinolysis after total hip arthroplasty. Clin Orthop Relat Res. 2002;399:168–176
  18. Gonzalez Della Valle A, Serota A, Go G, et al. Venous thromboembolism is rare with a multimodal prophylaxis protocol after total hip arthroplasty. Clin Orthop Relat Res. 2006;444:146–153
  19. Juelsgaard P, Larsen UT, Sorensen JV, et al. Hypotensive epidural anesthesia in total knee replacement without tourniquet: Reduced blood loss and transfusion. Reg Anesth. 2001;26:105–110
  20. Kiss H, Raffl M, Neumann D, et al. Epinephrine-augmented hypotensive epidural anesthesia replaces tourniquet use in total knee replacement. Clin Orthop Relat Res. 2005;436:184–189
  21. Sharrock NE, Gonzalez Della Valle A, Go G, et al. Potent anticoagulants are associated with a higher all-cause mortality rate after hip and knee arthroplasty. Clin Orthop Relat Res. 2008;466:714–721
  22. Sikorski JM, Hampson WG, Staddon GE. The natural history and aetiology of deep vein thrombosis after total hip replacement. J Bone Joint Surg [Br]. 1981;63:171–177
  23. Sharrock NE, Brien WW, Salvati EA, et al. The effect of intravenous fixed-dose heparin during total hip arthroplasty on the incidence of deep-vein thrombosis (A randomized, double-blind trial in patients operated on with epidural anesthesia and controlled hypotension). J Bone Joint Surg [Am]. 1990;72:1456–1461
  24. Huo MH, Salvati EA, Sharrock NE, et al. Intraoperative heparin thromboembolic prophylaxis in primary total hip arthroplasty (A prospective, randomized, controlled, clinical trial). Clin Orthop. 1992;274:35–46
  25. Huo MH, Salvati EA, Sharrock NE, et al. Intraoperative adjusted-dose heparin thromboembolic prophylaxis in primary total hip arthroplasty. Clin Orthop. 1992;277:188–196
  26. Planes A, Vochelle N, Fagola M. Total hip replacement and deep vein thrombosis. J Bone Joint Surg [Br]. 1990;72:9–13
  27. Binns M, Pho R. Femoral vein occlusion during hip arthroplasty. Clin Orthop. 1990;255:168–172
  28. Sharrock NE, Go G, Harpel PC, et al. Thrombogenesis during total hip replacement. Clin Orthop. 1995;319:16–27
  29. Sharrock NE, Go G, Sculco TP, et al. Dose response of intravenous heparin on markers of thrombosis during primary total hip replacement. Anesthesiology. 1999;90:981–987
  30. Westrich GH, Farrell C, Bono JV, et al. The incidence of venous thromboembolism after total hip arthroplasty: A specific hypotensive epidural anesthesia protocol. J Arthroplasty. 1999;14:456–463
  31. Sharrock NE, Go G, Mayman D, et al. Decreases in pulmonary artery oxygen saturation during total hip arthroplasty variations using 2 leg positioning techniques. J Arthroplasty. 2005;20:499–502
  32. Westrich GH, Specht LM, Sharrock NE, et al. Venous haemodynamics after total knee arthroplasty (Evaluation of active dorsal to plantar flexion and several mechanical compression devices). J Bone Joint Surg [Br]. 1998;80:1057–1065
  33. Salvati EA, Pellegrini VD, Sharrock NE, et al. Recent advances in venous thromboembolic prophylaxis during and after total hip replacement. J Bone Joint Surg [Am]. 2000;82-A:252–270
  34. Nassif JM, Ritter MA, Meding JB, et al. The effect of intraoperative intravenous fixed-dose heparin during total joint arthroplasty on the incidence of fatal pulmonary emboli. J Arthroplasty. 2000;15:16–21
  35. Westrich GH, Salvati EA, Sharrock N, et al. The effect of intraoperative heparin administered during total hip arthroplasty on the incidence of proximal deep vein thrombosis assessed by magnetic resonance venography. J Arthroplasty. 2005;20:42–50
  36. Sharrock NE, Go G, Sculco TP, et al. Changes in circulatory indices of thrombosis and fibrinolysis during total knee arthroplasty performed under tourniquet. J Arthroplasty. 1995;10:523–528

PII: S1045-4527(09)00056-X

doi: 10.1053/j.sart.2009.10.004

Seminars in Arthroplasty
Volume 20, Issue 4 , Pages 222-226 , December 2009

Article Tools

* Image Usage & Resolution