Epidural administration of drugs for pain relief in patients on low-dose aspirin

Epidural administration of local anaesthetics, opioids and steroids is often recommended in patients suffering from pain and who are receiving low-dose aspirin and non-steroidal anti-inflammatory drugs (NSAIDs). Both aspirin and the NSAIDs cause dysfunction of platelet aggregation and might be responsible for prolonged bleeding during the epidural intervention if a vessel is punctured. However, haemorrhagic complications following epidural injections in hundreds of these patients is rare. Therefore, no consensus can be found in the literature about a therapeutic protocol for the use of epidural medication in patients referred to the pain clinics while receiving low-dose aspirin and NSAIDs. In our pain unit we recommend that: (1) epidurals should not be administered unless aspirin cannot be discontinued for at least 1 week, (2) special care to avoid local trauma and a minimum 6 h observation after epidural puncture is mandatory; (3) there is no need for routine testing for bleeding time.