The impact of conduction anesthesia at the hemostastic system in the limb reperfusion syndrome in pediatric traumatology-orthopedic practice

Abstract

Introduction. Activation of the hemostatic system in the ischemia-reperfusion syndrome is a risk factor for thromboembolic complications during orthopedic surgical interventions associated with arterial tourniquet application. Therefore, it is relevant to find ways to mitigate reperfusion effects during such surgeries. Purpose. To find out character and effects of conduction anesthesia at the thromboelastogram parameters in the ischemic limb reperfusion after removing a tourniquet during orthopedic surgeries in children. Material and methods. The surgery which was performed in 20 patients from the traumatologic department in the City Children’s Clinical Emergency Hospital (Novosibirsk) required arterial tourniquet application. So, these patients were enrolled in the observational pilot study. The patients who had tourniquet application were distributed into two groups by the block randomization: Group 1 (n=10) – peripheric blockage; Group 2 (n=10) – no peripheric blockage. The basic technique used in the study was thromboelastography (TEG) with TEG5000 thromboelastograph (Haemonetics Corporation, USA). All patients had thromboelastography before tourniquet application (stage 1) and 5 minutes after its removal (stage 2). Main thromboelastogram parameters were assessed: R, measuring pathways for coagulation phases I and II; K – time, characterizing coagulation phase III; angle α, duplicating the information of “K” indicator; MA is the maximum amplitude of TEG branch divergence, characterizing the clot density which, in turn, depends on the function of platelet activity and on the amount of fibrinogen; LY30 is the percentage of clot lysed in 30 minutes. Results. In the group with regional anesthesia, indicators R, K, angle α, MA did not change at stage II; LY30 index decreased at stage 2. In the group without regional anesthesia, but with powerful central analgesic, indicators R, K, MA decreased, and angle α and LY30 increased at stage 2. Conclusion. In pediatric orthopedic surgeries with arterial tourniquet application , local anesthetic (Ropivacaine) in the conduction anesthesia technique prevented activation of the hemostastic system.