Regional anesthesia despite anticoagulation?
Anticoagulation always results in an increased probability of bleeding and can lead to increased bruising after injections of any kind. However, since these drugs are an important prophylaxis against strokes, heart attacks and similar diseases, discontinuation should always be carefully considered. Anticoagulants can lead to serious complications, particularly in the case of spinal or epidural anaesthesia.
There are many different active ingredients that belong to the anticoagulants. Depending on the drug, the risk varies. Some anticoagulants only need to be discontinued for a few hours before regional anesthesia.
These include heparins and Argatroban. ASA does not have to be discontinued at all. With dabigatran, rivaroxaban, danaparoid and other drugs, discontinuation for a few days is necessary.
Some anticoagulants must be discontinued one week before the procedure. These include clopidogrel and ticagrelor. Even after the procedure, certain minimum times must be observed before anticoagulation can be started. In principle, anesthesia procedures under anticoagulation remain individual case decisions and depend on many factors.
Complications
Complications are very rare in regional anesthesia procedures nowadays due to modern techniques and hygienic standards. Side effects that can occur during regional anesthesia are especially a drop in blood pressure. During an operation, the patient is connected to a monitor that can continuously record blood pressure values and heart actions.
This enables the anesthetist to react immediately in the event of a drop in blood pressure during regional anesthesia and to counteract this with medication. In some cases, bleeding or bruising may occur at the site where the drug was injected to numb the nerve or plexus with a needle. In rare cases, infections with various pathogens may also occur at this site.
The injected drug itself can also cause side effects in rare cases. These include dizziness, agitation, cardiac arrhythmia or seizures. Due to the further development of the drugs used in regional anesthesia, another side effect, the allergic reaction, has also become rare.
However, if an allergic reaction to the injected medication occurs, it is an absolute warning signal for the anaesthetist, as there is a risk of developing an allergic shock. An allergic shock is a medical emergency. Allergic shock can cause discomfort in various parts of the body, such as the skin, respiratory tract, or cardiovascular system and is potentially life-threatening.
If an allergic shock occurs during regional anesthesia, the supply of the painkilling medication must be stopped immediately and measures taken to stabilize the patient’s circulation. Furthermore, there is a possibility that the nerve may be directly damaged by the needle or cannula.
