Regional anesthesia and non-preeclamptic thrombocytopenia: time to re-think the safe platelet count.

BACKGROUND AND OBJECTIVES: Although regional anesthesia is widely used for pain control in obstetrics, it may not be appropriate for patients with thrombocytopenia due to the risk of neuraxial hematoma. There is no strong evidence to suggest the minimum platelet count that is necessary to ensure the safe practice of regional anesthesia. The purpose of this study was to review the safety of regional anesthesia in non-preeclamptic thrombocytopenic parturients at our institution over a 5-year period. METHODS: A retrospective chart review was performed in all the non-preeclamptic obstetric patients who delivered at our facility between April 2001 and March 2006, and had platelet counts < 100 x 10(9).L(-1) on the day of anesthesia. The etiology of the thrombocytopenia, type of anesthesia, mode of delivery and major anesthetic complications were noted. RESULTS: Seventy-five patients were identified, 47 of whom (62.6%) had received regional anesthesia. The etiology of their thrombocytopenia was immune thrombocytopenic purpura in 49 patients, gestational thrombocytopenia in 20 and other causes in 6 patients. Regional anesthesia was administered in 91.9% of the patients with platelet counts of 80 to 99 x 10(9).L(-1) and in 48.1% of the patients with platelet counts of 50 to 79 x 10(9).L(-1). None of the 11 patients with platelet counts below 50 x 10(9).L(-1) received regional anesthesia. There were no neurological complications. CONCLUSIONS: In our series, regional anesthesia was safely administered in pregnant patients with platelet counts between 50-79 x 10(9).L(-1). Our results are in keeping with other series in the literature. We suggest that in non-preeclamptic patients with stable platelet counts and no history or clinical signs of bleeding, the lower limit of platelet count for regional anesthesia should be 50 x 10(9).L(-1).

Anestesia regional e trombocitopenia não pré-eclâmptica: hora de repensar o nível seguro de plaquetas / Regional anesthesia and non-preeclamptic thrombocytopenia: time to re-think the safe platelet count / Anestesia regional y trombocitopenia no preclámptica: es hora de pensar de nuevo sobre el nivel seguro de plaquetas

JUSTIFICATIVA E OBJETIVOS: Apesar de a anestesia regional ser amplamente utilizada no controle da dor em obstetrícia, seu uso pode não ser apropriado nas pacientes com trombocitopenia por causa do risco de hematoma no neuroeixo. Não existem fortes evidências sugerindo número mínimo de plaquetas necessário para garantir a segurança na realização da anestesia regional. O objetivo deste estudo foi rever a segurança da anestesia regional em pacientes com trombocitopenia não pré-eclâmptica na instituição durante período de cinco anos. MÉTODO: Foi realizada revisão retrospectiva dos prontuários médicos de todas as pacientes obstétricas não pré-eclâmpticas cujo parto foi realizado na instituição entre abril de 2001 e março de 2006 e que apresentaram contagem de plaquetas < 100 x 109.L-1 no dia da anestesia. A etiologia da trombocitopenia, o tipo de anestesia, tipo de parto e as principais complicações anestésicas foram registrados. RESULTADOS: Foram identificadas 75 pacientes, das quais 47 (62,2%) receberam anestesia regional. A etiologia da trombocitopenia incluiu púrpura trombocitopênica imune, em 49 pacientes; trombocitopenia gestacional, em 20 pacientes; e outras causas em seis pacientes. Anestesia regional foi utilizada em 91,9% das pacientes com nível de plaquetas entre 80 a 99 x 109.L-1 e em 48,1% das pacientes com nível de plaquetas entre 50 e 79 x 109.L-1. Em nenhuma das 11 pacientes que apresentavam plaquetas abaixo de 50 x 109.L-1 foi administrada anestesia regional. Não houve complicações neurológicas. CONCLUSÕES: Nos casos estudados, a anestesia regional foi administrada com segurança nas gestantes com nível de plaquetas entre 50 - 79 x 109.L-1. Neste estudo os resultados são semelhantes aos de outras séries relatadas na literatura. Sugere-se que nas pacientes sem eclâmpsia com um nível estável de plaquetas e sem história prévia ou sinais clínicos de sangramento, o limite inferior de 50 x 109.L-1 deve ser adotado.

BACKGROUND AND OBJECTIVES: Although regional anesthesia is widely used for pain control in obstetrics, it may not be appropriate for patients with thrombocytopenia due to the risk of neuraxial hematoma. There is no strong evidence to suggest the minimum platelet count that is necessary to ensure the safe practice of regional anesthesia. The purpose of this study was to review the safety of regional anesthesia in non-preeclamptic thrombocytopenic parturients at our institution over a 5-year period. METHODS: A retrospective chart review was performed in all the non-preeclamptic obstetric patients who delivered at our facility between April 2001 and March 2006, and had platelet counts < 100 × 109.L-1 on the day of anesthesia. The etiology of the thrombocytopenia, type of anesthesia, mode of delivery and major anesthetic complications were noted. RESULTS: Seventy-five patients were identified, 47 of whom (62.6%) had received regional anesthesia. The etiology of their thrombocytopenia was immune thrombocytopenic purpura in 49 patients, gestational thrombocytopenia in 20 and other causes in 6 patients. Regional anesthesia was administered in 91.9% of the patients with platelet counts of 80 to 99 × 109.L-1 and in 48.1% of the patients with platelet counts of 50 to 79 × 109.L-1. None of the 11 patients with platelet counts below 50 × 109.L-1 received regional anesthesia. There were no neurological complications. CONCLUSIONS: In our series, regional anesthesia was safely administered in pregnant patients with platelet counts between 50-79 × 109.L-1. Our results are in keeping with other series in the literature. We suggest that in non-preeclamptic patients with stable platelet counts and no history or clinical signs of bleeding, the lower limit of platelet count for regional anesthesia should be 50 × 109.L-1.

JUSTIFICATIVA Y OBJETIVOS: A pesar de que la anestesia regional esté siendo muy utilizada en el control del dolor en obstetricia, su uso puede no ser muy apropiado en las pacientes con trombocitopenia, debido al riesgo de hematoma en el neuro eje. No existen fuertes evidencias que sugieran un número mínimo de plaquetas necesario para garantizar la seguridad en la realización de la anestesia regional. El objetivo de este estudio fue analizar la seguridad de la anestesia regional en pacientes con trombocitopenia no preeclámptica en la institución durante un período de cinco años. MÉTODO: Fue realizada revisión retrospectiva de las historias clínicas médicas de todas las pacientes obstétricas no preeclámpticas cuyo parto fue realizado en la institución entre abril de 2001 y marzo de 2006 y que presentaron < 100 x 109.L-1 de plaquetas el día de la anestesia. La etiología de la trombocitopenia, el tipo de anestesia, tipo de parto y las principales complicaciones anestésicas fueron registrados. RESULTADOS: Se identificaron 75 pacientes, de las cuales 47 (62,2%) recibieron anestesia regional. La etiología de la trombocitopenia incluyó púrpura trombocitopénica inmune en 49 pacientes, trombocitopenia de gestación en 20 pacientes, y otras causas en seis pacientes. La anestesia regional fue utilizada en un 91.9% de las pacientes con nivel de plaquetas entre 80 a 99 x 109.L-1 y en 48.1% de las pacientes con nivel de plaquetas entre 50 y 79 x 109.L-1. Ninguna de las 11 pacientes que presentaban plaquetas por debajo de 50 x 109.L-1 recibió anestesia regional. No hubo complicaciones neurológicas. CONCLUSIONES: En los casos estudiados, la anestesia regional fue administrada con seguridad en las gestantes con nivel de plaquetas entre...