Anticoagulation in the Setting of Epidural or Spinal Anesthesia/Analgesia

Abstract

IntroductionThe focus of this chapter is on the word “analgesia,” as used in the title. Although the traditional role of the anesthesiologist is to provide anesthesia, or total pain relief, for surgical procedures in the operating room, it is no longer possible to be considered a “compleat” anesthesiologist by ending patient care at the time that the surgical patient is turned over to the recovery room nurse. There is a growing specialty and societal expectation that the anesthesiologist will smooth the pathway for recovery by using specific drugs and techniques to control postoperative pain. Usually the postoperative period includes a period of 1 to 5 days.Why has the treatment of postoperative pain become such an issue? Can postoperative pain be effectively controlled in a more cost-effective manner than through the use of parenteral narcotics? In reality, narcotic drugs are not a cheap or effective approach. For example, any patient or nurse who has experienced post-thoracotomy pain control via the epidural route vs parenteral injections will testify to a preference for the epidural.1,2 When pain treatment is effective, there are multiple physiologic and economic spin-offs, such as better wound healing, decreased pulmonary infection rates, improved gastrointestinal function, shortened hospitalization time, and considerable savings of health care dollars.3-7