Neuraxial Drug Card - Anticoagulant Protocol for Performing Neuraxial Blocks

Question 1

Plavix

How long from the last dose before the BLOCK CAN BE ATTEMPTED?

Answer 1

7 days

Question 2

Plavix

How long from the last dose before an epidural CATHETER CAN BE REMOVED?

Answer 2

5-7 days

Question 3

Coumadin

How long from the last dose before the BLOCK CAN BE ATTEMPTED?

Answer 3

5 days, or INR <1.4

Question 4

Coumadin

How long from the last dose before an epidural CATHETER CAN BE REMOVED?

Answer 4

INR <1.4

Question 5

Heparin

How long from the last dose before the BLOCK CAN ATTEMPTED?

How long from the last dose before an epidural CATHETER CAN BE REMOVED?

Answer 5

4hrs, or normal PTT

Question 6

Heparin

How long after the BLOCK WAS PERFORMED before DOSING CAN RESUME?

How long after an epidural CATHETER IS REMOVED before DOSING CAN RESUME?

Answer 6

>=1hr

Question 7

Lovenox

How long from the last dose before the BLOCK CAN BE ATTEMPTED?

Answer 7

12hrs for normal doses
24hrs for higher doses

Question 8

Lovenox

How long from the last dose before an epidural CATHETER CAN BE REMOVED?

Answer 8

12-24hrs

Question 9

Lovenox

How long after the BLOCK WAS PERFORMED before DOSING CAN RESUME?

Answer 9

Germans say 4hrs
Americans say 24hrs

Question 10

Lovenox

How long after an epidural CATHETER IS REMOVED BEFORE DOSING CAN RESUME?

Answer 10

>=2hrs

Question 11

Aspirin/NSAIDs

Anticoagulant protocol?

Answer 11

“NSAIDs (including aspririn) do not significantly increase the risk of hematoma in patients recieving epidural or spinal anesthesia. The use of NSAIDs along should not interfere with the performance of neuraxial blocks or the timing of neuraxial catheter removal.” (Pharmacology in Anesthesia Practice, 2013, page 61)

Question 12

Marcaine Toxicity Protocol

Answer 12

Drug
Intralipid (20%) for Marcaine toxicity

Dose
1.5-3mL/kg (IV)
Max dose = 8mL/kg

• *Infusion**
  0. 25-0.5mL/kg/min (IV)