L. Lindgren et al., ERYTHROCYTE COUNTS IN THE CEREBROSPINAL-FLUID ASSOCIATED WITH CONTINUOUS SPINAL-ANESTHESIA, Acta anaesthesiologica Scandinavica, 39(3), 1995, pp. 396-400
Continuous spinal anaesthesia technique can be associated with peridur
al haemorrhage due to blood vessel damage caused by the needle or the
catheter. We studied whether thrombosis prophylaxis or anticoagulation
medications increase the risk of subarachnoid haemorrhage when contin
uous spinal anaesthesia is used. Twenty arthroplasty patients received
low-molecular-weight heparin preoperatively and twenty-two vascular s
urgery patients received heparin (100 IU kg(-1)) peroperatively; eight
of the latter patients were an regular preoperative antiplatelet medi
cation. Twenty-four prostate surgery patients, not exposed to heparin
or other drugs affecting coagulation, served as controls. A 22-gauge s
pinal catheter was used and bupivacaine was injected through the cathe
ter. Within the following 24 hours, 4-5 cerebrospinal fluid samples we
re collected for erythrocyte counts. In the arthroplasty and the vascu
lar group there were five patients each and in the control group seven
patients with more than 100 X 10(6) l(-1) erythrocytes in at least on
e of the samples. The highest erythrocyte count was 23900 X 10(6) l(-1
) in a control patient. The 22-hour sample was blood-ringed (erythrocy
tes >1000 X 10(6) l(-1)) in two patients in the arthroplasty group, in
one patient in the vascular group and in four patients in the control
group. In spite of the haemorrhages detected in this study, no relate
d neurological symptoms or other serious consequences were observed. T
he risk of subarnchnoid haemorrhage was not increased by drugs affecti
ng coagulation.