Surgical/tourniquet pain accelerates blood coagulability but not fibrinolysis

British Journal of Anaesthesia
S KohroA Namiki

Abstract

Tissue damage during surgery induces coagulation factors and activates platelets. Surgical pain may provoke release of catecholamines, leading to hypercoagulability. We have investigated the effect of surgical pain on blood coagulability and fibrinolysis in orthopaedic operations using tourniquets in 22 patients undergoing total knee replacement. Patients were allocated to one of two groups to receive extradural anaesthesia (EA; n = 11) or general anaesthesia (GA; n = 11). The EA group received lumbar extradural block with lidocaine. The GA group received only general anaesthesia, maintained with 1.5-2.5% sevoflurane and 66% nitrous oxide in oxygen. Using a thrombelastogram technique, blood coagulability and fibrinolysis were measured. Mean maximum amplitude (MA), which reflects coagulability, increased after tourniquet inflation (11%) in group GA whereas MA in group EA did not change. After tourniquet deflation, MA values in both GA and EA groups increased significantly (10% and 20%, respectively) (P < 0.05), and there was also a significant difference in MA between groups (P < 0.05). The fibrinolytic rate did not change in either group during tourniquet inflation, but increased significantly (160%) after tourniquet deflation....Continue Reading

Citations

Oct 16, 1999·Canadian Journal of Anaesthesia = Journal Canadien D'anesthésie·J HooperD H Johnson
Mar 4, 2014·Annales Françaises D'anesthèsie Et De Rèanimation·S Paul, B Debien
Nov 5, 2014·Knee Surgery, Sports Traumatology, Arthroscopy : Official Journal of the ESSKA·Jiang-tao DongShi-jun Gao
Dec 20, 2014·International Journal of Surgery Case Reports·Karan DesaiWyatt G Payne
Aug 15, 2003·The Cochrane Database of Systematic Reviews·P T ChoiJ Douketis
Jan 9, 2009·Clinical Orthopaedics and Related Research·Alan J R MacfarlaneRichard Brull
Jul 2, 2009·The Journal of Bone and Joint Surgery. British Volume·S HuZ-D Cai
Oct 3, 2006·Current Opinion in Anaesthesiology·T Mizobe

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