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

ABSTRACT

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