Warner Nafisseh S, Moeschler Susan M, Warner Matthew A, Hoelzer Bryan C, Eldrige Jason S, Bendel Markus A, Mauck William D, Watson James C, Gazelka Halena M, Lamer Tim J, Kor Daryl J, Hooten William Michael
From the *Department of Anesthesiology, †Division of Pain Medicine, and Departments of ‡Neurology and §Critical Care Medicine, Mayo Clinic, Rochester, MN.
Reg Anesth Pain Med. 2016 Jul-Aug;41(4):488-93. doi: 10.1097/AAP.0000000000000409.
Celiac plexus blockade has known risks including bleeding and neurologic injury because of the close proximity of vascular and neuraxial structures. The aim of this study was to determine the incidence of bleeding complications in patients undergoing celiac plexus block (CPB), with an emphasis on preprocedural antiplatelet medication use and coagulation status.
This is a retrospective study from 2005 to 2014 of adult patients undergoing CPB by the pain medicine division at a tertiary care center. The primary outcome was red blood cell (RBC) transfusion within 72 hours of needle placement, with a secondary outcome of bleeding complications requiring emergency medicine, neurology, or neurosurgical evaluation within 31 days.
A total of 402 procedures were performed on 298 unique patients, with 58 patients (14.4%) receiving aspirin or nonsteroidal anti-inflammatory drugs (NSAIDs) preoperatively. Five patients (1.2%) received RBC transfusion within 72 hours, of which one had received preprocedure NSAIDs. A platelet count measured within 30 days was available for 268 patients, with 7 patients (2.6%) having platelet counts of 100 × 10/L or less at the time of needle placement. A total of 187 patients had a valid preoperative international normalized ratio (INR), with 9 (4.8%) having an INR of 1.5 or higher (range, 1.5-2.6). One patient (11.1%) required RBC transfusion compared with an RBC transfusion rate of 2.3% (4 of 178) in those with normal INR (P = 0.221). We identified no bleeding complications requiring emergency medicine, neurology, or neurosurgical evaluation.
This study suggests that CPBs may be safely performed in patients receiving aspirin and/or NSAID therapy.
由于腹腔神经丛阻滞部位与血管和神经结构紧邻，腹腔神经丛阻滞存在包括出血和神经损伤在内的已知风险。本研究的目的是确定接受腹腔神经丛阻滞（CPB）患者出血并发症的发生率，重点关注术前抗血小板药物的使用和凝血状态。
这是一项对2005年至2014年在一家三级医疗中心疼痛医学科接受CPB的成年患者进行的回顾性研究。主要结局是在穿刺针放置后72小时内输注红细胞（RBC），次要结局是在31天内需要急诊科、神经内科或神经外科评估的出血并发症。
共对298例独特患者进行了402例手术，其中58例患者（14.4%）术前接受了阿司匹林或非甾体抗炎药（NSAIDs）治疗。5例患者（1.2%）在72小时内接受了RBC输注，其中1例术前接受了NSAIDs治疗。268例患者有30天内的血小板计数，7例患者（2.6%）在穿刺针放置时血小板计数为100×10/L或更低。共有187例患者有有效的术前国际标准化比值（INR），9例（4.8%）的INR为1.5或更高（范围为1.5 - 2.6）。1例患者（11.1%）需要输注RBC，而INR正常的患者中RBC输注率为2.3%（178例中有4例）（P = 0.221）。我们未发现需要急诊科、神经内科或神经外科评估的出血并发症。
本研究表明，接受阿司匹林和/或NSAID治疗的患者可以安全地进行CPB。
