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Abstract
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Background and Aims In patients receiving vitamin-K antagonist treatment, deep nerve procedures should be performed according to the recommendations for neuroaxial procedures. However, the guideline may not be clear for superficial nerve blocks, especially if the INR is above target range.
Methods The present case concerns a 77-year-old female patient under acenocoumarol therapy owing to a double mechanical valve prothesis and chronic atrial fibrillation. Additionally, her medical history includes a tricuspid valvuloplasty, severe pulmonary arterial hypertension, and a restrictive lung disease. The patient was referred from another medical center due to a hematoma in the left lower extremity resulting from a contusion. The hematoma was causing a compartment syndrome, and the INR value was 4.1. In this context, an urgent drainage of the hematoma was indicated, and the anticoagulation was reversed using 10 mg of vitamin K and 1000UI of prothrombin complex. Subsequently, popliteal sciatic nerve block was performed under ultrasound and neurostimulation guidance, with 20 ml of 1% mepivacaine and 0.25% bupivacaine.
Results The hematoma drainage was successfully performed. During the procedure, a minimal sedation had to be administered as the surgical wound was extended to the medial leg, an area not covered by the sciatic block. Additionally, red blood cell transfusion was required due to significant blood loss.
Conclusions Peripheral nerve blocks can be administered to patients who are taking anticoagulants. However, tailoring each case by considering patient‘s characteristics, the target INR, and the nerve block’s characteristics, such as compressibility, vascularization, and potential consequences of bleeding if it occurs, is likely the best practice.
Dranaige of the hematoma in the lateral area of the leg during the intraoperative period