Orthopedics
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Spinal hematoma is a rare and potentially catastrophic complication of spinal or epidural anesthesia. Risk factors include traumatic needle/catheter placement, sustained anticoagulation in an indwelling neuraxial catheter, and catheter removal during therapeutic levels of anticoagulation. ⋯ Signs of cord compression, such as severe back pain, progression of numbness or weakness, and bowel and bladder dysfunction, warrant immediate radiographic evaluation. A delay in diagnosis and intervention of spinal hematoma may lead to irreversible cord ischemia.
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Deep vein thrombosis and pulmonary embolism are major causes of morbidity and mortality after knee and hip arthroplasty in the United States. Although patients frequently receive prophylaxis for thromboembolism postarthroplasty, surgeons vary in their choice of modality and often use suboptimal strategies due to the possibility of provoking postoperative bleeding. ⋯ Supporting medical evidence for these recommendations is described. A summary of current prophylactic regimens and discussion of duration of therapy are also presented.