Increased fibrinolysis and changes in blood coagulation during epidural block for transurethral prostatectomy.

ABSTRACT

Epidural analgesia is the choice of anesthesia for transurethral prostatectomy (TURP). Unfortunately, this technique may increase fibrinolysis as well as decrease in fibrinogen and platelets count, which might cause deleterious bleeding problem during the procedure performed under epidural block. The present study was therefore undertake to assess the degree of increased fibrinolysis and changes in coagulation profiles during epidural anesthesia for TURP. Twenty patients aged from 57 to 83 years were studied. Group 1 of 7 patients did not receive antifibrinolysin (transamin) after 20 minutes following epidural block. Group 11 of 13 patients did not receive transamin intravenously. Blood samples were drawn for euglobulinlysis time (ELT), fibrinogen, platelets, haemoglobin, prothrombin time (PT) and partial thromboplastin time (PTT). The sampling periods included pre-epidural block as baseline values, 10 and 45 minutes after epidural block and the last was obtained immediately after the completion of surgery. The study revealed the same degree of increased fibrinolysis in both groups tested ten minutes after epidural analgesia and throughout the entire operation. There were no statistical significant changes in fibrinogen level, PT and PTT. The platelet counts decreased from the baseline values in group 1 more than group 11, but the quantities were within normal ranges. The results indicated that fibrinolysis following epidural analgesia for TURP increased in the same degree in all patients if either they received transamin or not. Furthermore, the increased fibrinolytic activity did not lead to a problem of blood loss in this study.