Key result
High epidural analgesia resulted in a smaller increase in the Factor VIII complex compared to general anaesthesia during abdominal hysterectomy, with no significant differences in other variables.
Why the study?
Does high epidural analgesia compared to general anaesthesia alter coagulation and fibrinolytic variables in premenopausal women undergoing abdominal hysterectomy?
Observational (n=20)
Does high epidural analgesia compared to general anaesthesia alter coagulation and fibrinolytic variables in premenopausal women undergoing abdominal hysterectomy?
Epidural analgesia suppresses the increase in Factor VIII complex compared to general anaesthesia during abdominal hysterectomy, which may explain the lower postoperative thromboembolic risk associated with epidural analgesia.
Answers are grounded in this paper and cite their sources.
Epidural analgesia attenuates Factor VIII rise in hysterectomy; hypothesis-generating for thromboembolic benefit, needs prospective confirmation.
Blood coagulation and fibrinolysis were studied in 20 premenopausal women undergoing abdominal hysterectomy under general anaesthesia (GA) or high epidural analgesia (EDA). As expected, the adrenocortical stress response was suppressed in the EDA group. The Factor VIII complex (F VIII:C, F VIII R:Ag = von Willebrand factor), known to be related to adrenocortical activity and/or vessel wall reactivity, was found to increase less in the EDA group. With regard to all the other variables analysed there were no significant differences between the groups. With both anaesthetic procedures activation of coagulation could be demonstrated by a decrease in prekallikrein, F X and antithrombin as well as by an increase in fibrinopeptide A levels. A decrease in plasminogen and alpha 2-antiplasmin suggested activation of the fibrinolytic system and a decrease in prekallikrein and kallikrein inhibition activity (C-1-esterase inhibitor) an activation of the kallikrein system. In this study only the differences in F VIII complex could explain the previously reported higher thromboembolic frequency after GA as compared to EDA.
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Bredbacka et al. (1986) conducted an observational in Abdominal hysterectomy (n=20). High epidural analgesia (EDA) vs. General anaesthesia (GA) was evaluated on Changes in coagulation and fibrinolytic variables (including Factor VIII complex). High epidural analgesia resulted in a smaller increase in the Factor VIII complex compared to general anaesthesia during abdominal hysterectomy, with no significant differences in other variables.
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