Effects of the Regional Nerve Blockade at the Limb Reperfusion in Pediatric Orthopedics

Abstract

Introduction. Arterial tourniquets are widely used to improve visualization of the surgical field and to reduce blood loss . However, the resulting ischemia and subsequent reperfusion make doctors seek for better options to reduce these complications. Objective. To find out how the regional nerve blockade impacts the reperfusion of ischemized limb when arterial tourniquets are removed during orthopedic surgeries in children. Material and methods. In 16 patients, who were operated on at the department of trauma and orthopedics of the Novosibirsk Children ‘s Clinical Hospital of Emergency Medical Care (CCHEMC) , surgical intervention required the application of an arterial tourniquet. These patients became participants in an observational pilot study. Patients with tourniquets were divided into two groups: Group I - had the regional nerve blockade ( 9 patients) and Group II - had no regional nerve blockade (7 patients). Parameters of acid-base homeostasis, lactate and arterial blood glucose were assessed in all patients at all stages: before surgery (stage 1), main stage (stage 2), 5 minutes after the tourniquet removal (stage 3). The following parameters were compared in this work: mean arterial pressure (MAP), mm Hg; heart rate (min-1); concentration of lactate in the arterial blood (mmol/l), glycemia (mmol/l). The obtained findings are presented as median (Me) of lower and upper quartiles [Q25; Q75]. Results. The found dynamics of lactate concentration in participants’ blood was the most significant result of the study. In Group I, where regional anesthesia was used, lactate level decreased at the stage 2 and returned to its baseline at the stage 3. In Group II (without regional anesthesia, but with a powerful central analgesic preparation) , lactate level did not change at stage 2, but significantly increased at stage 3. Conclusion. Topical anesthetic (Ropivakaine), used in the regional nerve blockade during orthopedic surgeries in children when arterial tourniquets are put, has less harmful effects in surgical aggression.

Endocrine and metabolic monitoring for anesthesia care in orthopedic trauma surgery on the lower extremities of children: prospective comparative study

“…Регионарная анестезия обеспечивает блокаду афферентной ноцицептивной импульсации и способна предотвратить трансдукцию боли и её трансмиссию до спинального уровня, что снижает адренергическую симпатическую стимуляцию, выработку адренокортикотропного гормона и катехоламинов [12]. Наиболее доступными в клинической практике и информативными показателями, определяющими выраженность хирургического стресс-ответа, являются кортизол, глюкоза и лактат.…”