The Role of Regional Anesthesia in Decreasing Thromboembolism

To the Editor.— Dr Coon¹ discusses the role of anticoagulants in decreasing the incidence of thromboembolism after total hip replacement, but he does not mention the contribution of anesthesia. Regional (spinal or epidural) anesthesia for orthopedic surgery significantly reduces the likelihood of thromboembolism compared with general anesthesia.^2-4 However, in the case of surgery for a fractured hip, the improvement fades over a period of months, when other unidentified factors equalize the mortality after general vs regional anesthesia.⁵

There is a possibility of increased blood loss when anticoagulants are used to avoid thromboembolism; regional anesthesia also reduces blood loss and the need for transfusion.² For the patient in question for whom there might be difficulty in obtaining compatible blood, autologous donation of blood and a regional anesthetic should be considered as ways to decrease the risk of thromboembolism and the need for heterologous transfusion.