Epidural anaesthesia in patients receiving prophylactic low molecular weight heparin [enoxaparin] during total hip replacement

This study was designed to determine the effect of LMWH as a prophylactic to reduce the prevalence of DVT after total hip replacement [THR] and to assess any haemorrhagic, soft tissue side effects or epidural haematoma after the use of LMWH. This study was carried out on 60 adult patients scheduled for total hip replacement under epidural anaesthesia. They were randomly classified into two groups: Group I [30 patients] received subcutaneous low molecular weight heparin [LMWH] enoxaparin 40 mg, 12 hour pre -operatively then after 12 h and 36 h postoperatively. Group II [30 patients] control group, did not receive enoxaparin. Haemorrhagic side effects were assessed by measurement of haemoglobine level, prothrombin time, partial thromboplastine time and platelets count, also we assessed blood loss and soft tissue complications as wound discharge and bruising of the leg. Both groups showed no significant difference in haemoglobin level and other blood laboratory tests in the pre -and postoperative period also there were no significant difference in haemorrhagic side effects or wound discharge but there was more bruising in the enoxaparin group, eight patients [13.3%] experienced minor neurologic complications or low back pain which was self limited and resolved with time. There were no manifestations of epidural haematoma leading to spinal cord compression. Proper patient selection, atraumatic technique, good monitoring, then administration of enoxaparin at least 12 hour before regional anaesthesia, removal of the catheter when the circulating LMWH is low after 10-12 hour from last injection and start the subsequent dose after 2 hours from removal of the catheter, should minimize the occurrence of epidural haematoma

Comparison of epidural analgesia with 0.125% ropivacaine with fentanyl versus 0.125% bupivacaine with fentanyl during labour

Fifty labouring women were randomized to receive either 0.125% ropivacaine with fentanyl 2 ug/ml or an equivalent concentration of bupivacaine / fentanyl using patient controlled epidural analgesia [PCEA] with settings of :6ml/h basal rate , 5ml bolus, lO.rnin lockout, 30ml/h dose limit.Analgesia, local anaesthetic use, motor block, patient satisfaction and side effects were assessed until the time of delivery. No differences in verbal pain scores, local anesthetic use , patient satisfaction or side effects between groups were observed. Hourly local anesthetic use was similar and did not differ between groups . the mean total volume of ropivacaine /fentanyl administered from epidural catheter placement until delivery was 85.3 +/- 30.6ml ropivacaine and 170.6 +/- 61.2 ug . fentanyl versus 88.2 +/- 25.2ml bupivacaine. and 176.4 +/- 50.4 ug fentanyl PCEA demands and delivered doses were similar between groups however patients administered ropivacaine / fentanyl developed significantly less motor block than an equivalent concentration of bupivacaine / fentanyl.. this statistical significant reduction in motor block decreased the incidence of instrumental delivery in ropivacaine/fentanyl group . Neonatal assessment included APGAR scores umbilical cord blood gas analysis and neurobehavioral testing at delivery,2 and 24h of life using the neurologic and adaptive capacity score [NACS] were reported . Neonatal condition was good and generally similar in all groups. In summary, by using a patient controlled epidural analgesia technique, ropivacaine 0.125% with fentanyl 2ug/ml produces similar analgesia with significantly less motor block than similar concentration of bupivacaine with fentanyl during labour without detrimental effects to the foetus