Regional Anaesthesia and Coagulation Disorder

Regional anaesthesia has truly reached its pinnacle with the introduction of newer and safer modalities. However, it is not without its share of drawbacks and shortcomings. A steady rise in the incidence of thromboembolism and a large pool of patients on antithrombotic medications pose serious safety concerns in patients receiving regional anaesthesia. Individuals with hereditary disorders of coagulation constitute a far smaller proportion, but due to the scarcity of large data points and literature, there is no consensus about the safety of regional anaesthesia in this subset of patients. Given that haemorrhagic complications like vertebral canal haematoma in these patients may be catastrophic and debilitating, it becomes essential to be well-versed with the specific concerns and necessary amendments that may be crucial to individualize the administration of regional anaesthesia in these patients. There is no inviolable approach, and therefore, all cases should be evaluated meticulously and risk stratified individually. Thorough risk–benefit analysis forms the cornerstone of management. However, this chapter aims to provide practical problem-solving scenarios and clear direction not only for anaesthesiology trainees but also for practising anaesthesiologists.