Bleeding complications in patients undergoing celiac plexus block

Nafisseh S. Warner, Susan M. Moeschler, Matthew Warner, Bryan C. Hoelzer, Jason S. Eldrige, Markus A. Bendel, William D. Mauck, James Watson, Halena M. Gazelka, Tim J. Lamer, Daryl J Kor, William Michael Hooten

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Background and Objectives: Celiac plexus blockade has known risks including bleeding and neurologic injury because of the close proximity of vascular and neuraxial structures. The aim of this study was to determine the incidence of bleeding complications in patients undergoing celiac plexus block (CPB), with an emphasis on preprocedural antiplatelet medication use and coagulation status. Methods: This is a retrospective study from 2005 to 2014 of adult patients undergoing CPB by the pain medicine division at a tertiary care center. The primary outcome was red blood cell (RBC) transfusion within 72 hours of needle placement, with a secondary outcome of bleeding complications requiring emergency medicine, neurology, or neurosurgical evaluation within 31 days. Results: A total of 402 procedures were performed on 298 unique patients, with 58 patients (14.4%) receiving aspirin or nonsteroidal anti-inflammatory drugs (NSAIDs) preoperatively. Five patients (1.2%) received RBC transfusion within 72 hours, of which one had received preprocedure NSAIDs. A platelet count measured within 30 days was available for 268 patients, with 7 patients (2.6%) having platelet counts of 100 × 109/L or less at the time of needle placement. A total of 187 patients had a valid preoperative international normalized ratio (INR), with 9 (4.8%) having an INR of 1.5 or higher (range, 1.5-2.6). One patient (11.1%) required RBC transfusion compared with an RBC transfusion rate of 2.3% (4 of 178) in those with normal INR (P = 0.221). We identified no bleeding complications requiring emergency medicine, neurology, or neurosurgical evaluation. Conclusions: This study suggests that CPBs may be safely performed in patients receiving aspirin and/or NSAID therapy.

Original languageEnglish (US)
Pages (from-to)488-493
Number of pages6
JournalRegional Anesthesia and Pain Medicine
Volume41
Issue number4
DOIs
StatePublished - Jun 21 2016

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Celiac Plexus
Hemorrhage
Erythrocyte Transfusion
International Normalized Ratio
Anti-Inflammatory Agents
Emergency Medicine
Neurology
Platelet Count
Aspirin
Needles
Nervous System Trauma
Tertiary Care Centers
Pharmaceutical Preparations
Blood Vessels
Retrospective Studies

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine

Cite this

Warner, N. S., Moeschler, S. M., Warner, M., Hoelzer, B. C., Eldrige, J. S., Bendel, M. A., ... Hooten, W. M. (2016). Bleeding complications in patients undergoing celiac plexus block. Regional Anesthesia and Pain Medicine, 41(4), 488-493. https://doi.org/10.1097/AAP.0000000000000409

Bleeding complications in patients undergoing celiac plexus block. / Warner, Nafisseh S.; Moeschler, Susan M.; Warner, Matthew; Hoelzer, Bryan C.; Eldrige, Jason S.; Bendel, Markus A.; Mauck, William D.; Watson, James; Gazelka, Halena M.; Lamer, Tim J.; Kor, Daryl J; Hooten, William Michael.

In: Regional Anesthesia and Pain Medicine, Vol. 41, No. 4, 21.06.2016, p. 488-493.

Research output: Contribution to journalArticle

Warner, NS, Moeschler, SM, Warner, M, Hoelzer, BC, Eldrige, JS, Bendel, MA, Mauck, WD, Watson, J, Gazelka, HM, Lamer, TJ, Kor, DJ & Hooten, WM 2016, 'Bleeding complications in patients undergoing celiac plexus block', Regional Anesthesia and Pain Medicine, vol. 41, no. 4, pp. 488-493. https://doi.org/10.1097/AAP.0000000000000409
Warner, Nafisseh S. ; Moeschler, Susan M. ; Warner, Matthew ; Hoelzer, Bryan C. ; Eldrige, Jason S. ; Bendel, Markus A. ; Mauck, William D. ; Watson, James ; Gazelka, Halena M. ; Lamer, Tim J. ; Kor, Daryl J ; Hooten, William Michael. / Bleeding complications in patients undergoing celiac plexus block. In: Regional Anesthesia and Pain Medicine. 2016 ; Vol. 41, No. 4. pp. 488-493.
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abstract = "Background and Objectives: Celiac plexus blockade has known risks including bleeding and neurologic injury because of the close proximity of vascular and neuraxial structures. The aim of this study was to determine the incidence of bleeding complications in patients undergoing celiac plexus block (CPB), with an emphasis on preprocedural antiplatelet medication use and coagulation status. Methods: This is a retrospective study from 2005 to 2014 of adult patients undergoing CPB by the pain medicine division at a tertiary care center. The primary outcome was red blood cell (RBC) transfusion within 72 hours of needle placement, with a secondary outcome of bleeding complications requiring emergency medicine, neurology, or neurosurgical evaluation within 31 days. Results: A total of 402 procedures were performed on 298 unique patients, with 58 patients (14.4{\%}) receiving aspirin or nonsteroidal anti-inflammatory drugs (NSAIDs) preoperatively. Five patients (1.2{\%}) received RBC transfusion within 72 hours, of which one had received preprocedure NSAIDs. A platelet count measured within 30 days was available for 268 patients, with 7 patients (2.6{\%}) having platelet counts of 100 × 109/L or less at the time of needle placement. A total of 187 patients had a valid preoperative international normalized ratio (INR), with 9 (4.8{\%}) having an INR of 1.5 or higher (range, 1.5-2.6). One patient (11.1{\%}) required RBC transfusion compared with an RBC transfusion rate of 2.3{\%} (4 of 178) in those with normal INR (P = 0.221). We identified no bleeding complications requiring emergency medicine, neurology, or neurosurgical evaluation. Conclusions: This study suggests that CPBs may be safely performed in patients receiving aspirin and/or NSAID therapy.",
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AU - Bendel, Markus A.

AU - Mauck, William D.

AU - Watson, James

AU - Gazelka, Halena M.

AU - Lamer, Tim J.

AU - Kor, Daryl J

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