Visoiu Mihaela, Yang Charles
Department of Anesthesiology, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, PA, USA.
Paediatr Anaesth. 2011 Apr;21(4):459-62. doi: 10.1111/j.1460-9592.2010.03511.x. Epub 2011 Jan 18.
Regional anesthesia techniques commonly utilized in post-operative pain management are often considered contraindicated in coagulopathic patients. We report on successful postoperative pain control utilizing peripheral nerve blockade after exploratory laparotomy with small bowel resection in a mildly coagulopathic patient. In our case, complicated by abnormal PT, PTT and INR, a thromboelastogram (TEG) was performed before the procedure and found to be normal. An ultrasound-guided bilateral paravertebral blockade with continuous paravertebral catheters was then performed in this pediatric patient without complications. The patient expressed satisfaction with his pain control. More studies are needed to evaluate the validity of TEG in the prediction of bleeding risk and the safety of this regional technique in a mildly coagulopathic patients.
术后疼痛管理中常用的区域麻醉技术通常被认为在凝血功能障碍患者中是禁忌的。我们报告了一例轻度凝血功能障碍患者在小肠切除术后行剖腹探查术，通过外周神经阻滞成功控制术后疼痛的病例。在我们的病例中，患者存在PT、PTT和INR异常，术前进行了血栓弹力图（TEG）检查，结果正常。然后对该儿科患者实施了超声引导下双侧椎旁阻滞并留置连续椎旁导管，未出现并发症。患者对疼痛控制表示满意。需要更多研究来评估TEG在预测出血风险方面的有效性以及该区域技术在轻度凝血功能障碍患者中的安全性。
