use of clexane in spinal anesthesia

[bhavin.shah]

hi,
   we are doing total knee arthroplasy. we routinely use inj. clexane for prevention of D.V.T.
  We usually give spinal/epidural.
   my query is," when should we start clexane? preop or postop? if postop, then after how much time of spinal anesthesia? if we have traumatic spinal tap, then what to do?
   regards.

[jafo1964]

Epidural Needle placement
12 hrs after last dose of LMWH
first postoperative dose 4-12 hours after needle placement
catheters removed 10-12 hours  after LMWH and 4 hours prior to next dose;
postpone LMWH  by 24 hours if traumatic


The above mentioned are the ASRA guidelines for Anticoagulatns and Neuraxial blocks

There is a little difference if you follow the other  guidelines like spanish or German

regs