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| |  WCA: Fondaparinux Does Not Boost Risk of Perineural Haematoma After Continuous Nerve Block in Orthopaedic Surgery Patients By Jill Stein PARIS, FRANCE -- April 19, 2004 -- Early data suggest that fondaparinux (Arixtra) fondaparinux (Arixtra) does not increase the likelihood of perineural haematoma in patients undergoing continuous nerve block techniques, including lumbar plexus blocks, for postoperative analgesia after lower extremity joint replacement. The low-molecular-weight heparin (LMWH) fondaparinux is a synthetic selective inhibitor of factor Xa. Dr. Jacques E. Chelly, University of Pittsburgh Medical Center Presbyterian-Shadyside Hospital, Pittsburgh, Pennsylvania, United States, presented the findings here on April 19th at the 13th World Congress of Anaesthesiologists. "The combination of low-molecular-weight heparins and epidural analgesia has been estimated to increase the risk of epidural haematoma by 50-fold," Dr. Chelly pointed out. "Only one case of self -contained, spontaneously reversible psoas haematoma has been reported with the combination of the LMWH enoxaparin and a lumbar plexus block [Klein et al. Anesthesiology. 1997;87:1576-1579; Weller RS et al, Anesthesiology. 2003;98:581-585]." Previously, an analysis of 4 large, phase 3 studies that enrolled a total of 7,344 patients undergoing orthopaedic surgery, researchers found that a once-daily subcutaneous 2.5 mg dose of fondaparinux starting 6 hours postoperatively provided a reduction of more than 50% in the incidence of venous thromboembolism compared to the LMWH enoxaparin (P < .01), without increasing the incidence of clinically important bleeding (Alexander et al. Arch Intern Med. 2002;162:1833-1840). In the present study, Dr. Chelly's team reviewed the case records for 92 consecutive patients undergoing either total knee or hip replacement surgery under spinal or general anaesthesia at their institution. Patients undergoing elective total hip replacement received a continuous lumbar plexus block with or without a single sciatic nerve block using a gluteal approach. Patients undergoing elective total knee replacement received a continuous femoral block, with or without either a single or continuous sciatic nerve block using a gluteal approach. The choice of the anaesthesia technique was made by the anaesthesiologist. The perineural catheters were removed while the patients were receiving thromboprophylaxis. The lumbar plexus and sciatic catheters were removed on the second postoperative day, and the femoral catheters were removed on the third post-operative day. Fondaparinux 2.5 mg once daily was started the morning after surgery, and thromboprophylaxis was continued at least until hospital discharge. At discharge, Doppler ultrasonography was used to screen patients for deep venous thrombosis. Results showed that the placement and removal of the sciatic, femoral, and lumbar plexus perineural catheters were not associated with perineural bleeding, anaemia, or any neurological deficit suggesting a perineural haematoma. No cases of deep-vein thrombosis were detected. Dr. Chelly emphasised that more research is needed to corroborate the results.
[Study title: Fondaparinux (Arixtra) thromboprophylaxis in major orthopaedic surgery patients does not increase the risk of perineural haematoma following continuous nerve block. Abstract 210]
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