[Lumbar analgesia in patients receiving anticoagulation therapy: pro et contra]

Employment of lumbar blockade and thrombosis prophylatic therapy for surgical patient are appropriate. It is, however, controversial, whether the combination is safe for the patient. It is not known whether the incidence of haematomata in the spinal canal increases after the combination as insufficient prospective reviews are available. As several cases of epidural haematomata following regional blockade in patients receiving regular anticoagulation therapy have been reported, this combination must be advised against, as a rule. Only an isolated case of epidural haematoma has been reported in a patient receiving subcutaneous low-dose heparin therapy and isolated cases of haematoma formation in patients receiving prostaglandin-antagonists. Regional analgesia for patients of this type is considered safe, unless other predisposition to haemorrhage is present. Observance of a series of technical rules probably reduces the risk for local haemorrhage after lumbar block. Early diagnosis and treatment of symptom-producing haematomata in the spinal canal is important.