Intraoperative Techniques to Reduce Thromboembolism: Regional Anesthesia and Intraoperative Heparin

Both neural blockade (spinal or epidural) have been shown to reduce the risk of thrombogenesis after both hip and knee arthroplasty. The mechanism is most likely due to enhanced blood flow in the deep venous system of the legs. Reduction in blood loss during and after surgery may also play a role. Intraoperative heparin during hip and knee arthroplasty in doses of 10-15 U/kg suppresses thrombogenesis without increasing the risk of bleeding. Both these modalities are focused intraoperatively—the period when thrombi initially form.