Regional Anesthesia in the Patient Receiving Antithrombotic or Thrombolytic therapy

Basic Principles and Terminology

The following definitions are used For the purposes of these guidelines:

➡️Anesthesiologist: the term anesthesiologist in this document is used to designate all licensed medical practitioners with privileges to administer anesthetics, surgical intensive care, pain management, perioperative care, and resuscitation. 

➡️Antithrombotic therapy: a medical approach using medications to prevent or treat blood clots (thrombosis) in arteries and veins, reducing risks of stroke, heart attack, and venous thromboembolism.

➡️Autonomic Dysfunction: New-onset urinary retention or fecal incontinence.

➡️Back Pain: Severe, localized back pain, often described as "stabbing" or radiating to the legs.

➡️Hematoma: is a collection of blood that pools outside of blood vessels, usually caused by injury or trauma to veins or arteries. 

➡️Motor Deficit: New or progressive extremity weakness (unable to perform a straight leg raise).

➡️Neuraxial anesthesia: is a regional anesthetic technique involving the injection of medication (local anesthetics, often with opioids) into the cerebrospinal fluid or epidural space to block nerve conduction at the spinal cord/nerve root levels.

➡️Regional anesthesia: a pain management technique that uses injections of local anesthetics to block nerves, numbing a specific, large area of the body (e.g., limbs, abdomen, or lower body) while the patient remains conscious or sedated.

➡️Sensory Deficit: New or worsening numbness or "heaviness" in a dermatomal distribution.

➡️Thrombolytic therapy: an emergency medical procedure that uses special medication, known as "clot-busters" (e.g., tissue plasminogen activator or tPA), to dissolve dangerous, deep-seated blood clots.

➡️t-PA formulations: Tissue-type plasminogen activator (tPA) formulations include recombinant, FDA-approved thrombolytic agents (alteplase, reteplase, tenecteplase) for ischemic stroke, myocardial infarction, and pulmonary embolism.

➡️Traumatic Tap: is defined as the aspiration or spontaneous appearance of blood in the needle or catheter during the performance of a regional anesthetic technique.