[Effect of different analgesia combined with low molecular heparin on hemorheology and coagulation in patients undergoing total hip replacement].

OBJECTIVE

To observe the effect of different analgesia combined with low molecular heparin (LMWH) on hemorheology and coagulation in patients undergoing total hip replacement (THR).

METHODS

Patients undergoing THR with spinal combined epidural anesthesia (SCEA) were randomized to one of four groups: group E(0) received patient-controlled epidural analgesia (PCEA) without LMWH; group E(L) sames but combined with LMWH; group I(0) received patient-controlled intravenous analgesia (PCIA) without LMWH and I(L) the sames but combined with LMWH. Venous blood samples were taken after hospitalization, at the end of operation, 24 h, 48 h and 7 d after operation for determination of hemorheology, indexes of coagulation function. Visual analogue scale (VAS) scores were recorded at 24 h and 48 h postoperation. All the patients received colour Doppler ultrasonography examination before operation, and on the 7th day after operation. Complication of preoperation were recorded.

RESULTS

There was no significant change in VAS among the four groups. The rates of DVT occurrence in group I(L) and E(L) were significantly lower than in group I(0) and E(0)(P < 0.05), and there was no significant difference between group I(L) and E(L) or between group I(0) and E(0). The incidence of nausea was markedly higher in group I(L) than that in group E(0) and E(L). Fib of all patients were significantly decreased at the end of operation and 24 h postoperation compared with base line values (P < 0.05), there was no significant difference each other in the four groups. Plasma viscosity and blood viscosity were lower in group E(0) than in group I(0) after operation (P < 0.05), and lower in group I(L) and E(L) than in group E(0) and group I(0) after operation (P < 0.05). There was no significant difference in plasma viscosity and blood viscosity between group I(L) and E(L). There was no significant change in PT and APTT in group I(0) and E(0) at all times, and no difference between the two groups. PT and APTT in group I(L) and E(L) were significantly prolonged at the end of operation and after operation compared with baseline values (P < 0.05), and prolonged compared with group I(0) and E(0) (P < 0.05). There was no difference in preoperation bleeding among all groups.

CONCLUSION

PCEA can improve hemorheology significantly compared with PCIA in patients undergoing THR without LMWH. Combined with LMWH preoperation, both PCEA and PCIA can reduce occurrence of venous thrombosis, improve coagulation function and hemorheology without increase of bleeding. Intraspinal anesthesia and PCEA are safe and feasible in patients received LMWH preoperation of THR. PCEA wasn't superior to PCIA in prophylaxis against postoperative venous thromboembolism when combined with LMWH.