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Anesth Analg 1987; 66:267-268
© 1987 International Anesthesia Research Society
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Caudal Administration of Morphine Sulfate in Anticoagulated and Thrombocytopenic Patients

Steven D. Waldman, MD, Gary S. Feldstein, MD, Howard J. Waldman, DO, Katherine A. Waldman, BS, and Mark L. Allen, MD

Received from the Kansas City Pain Consortium, University of Missouri-Kansas City.

Abstract

Anticoagulation and profound thrombocytopenia are among the few absolute contraindications to regional anesthesia (1,2). The risk of epidural hematoma is well documented as a rare complication in fully anticoagulated patients given spinal or epidural anesthesia (1,3–6). The issue of the relative safety of regional anesthesia in patients on "minidose" heparin remains unsettled. Should surgery be necessary in an anticoagulated patient, general anesthesia is considered a safer option.

Unfortunately for the patient who is suffering from intractable pain of malignant origin and who is also receiving anticoagulants, the options of techniques for pain relief other than regional anesthesia are more limited.

We report on 37 patients that were fully anticoagulated and 19 patients with profound thrombocytopenia suffering from intractable pain of malignant origin who underwent 336 caudal blocks with morphine sulfate and bupivacaine for pain control, and we review the safety of this approach.




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M. A. Chaney
Intrathecal and Epidural Anesthesia and Analgesia for Cardiac Surgery
Anesth. Analg., January 1, 2006; 102(1): 45 - 64.
[Abstract] [Full Text] [PDF]


Lippincott, Williams & Wilkins Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins with the assistance of Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999 HighWire Press
Copyright © 1987 by the International Anesthesia Research Society.