Epidural Anesthesia Prevents Hypercoagulation in Patients Undergoing Major Orthopedic Surgery

Hollmann, Markus W.; Wieczorek, Kathrin; Smart, Mary; Durieux, Marcel E.

doi:10.1097/00115550-200105000-00004

Cited by 63 publications

(12 citation statements)

References 17 publications

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“…There is growing evidence that local anaesthetics can act on G protein‐coupled receptors, which are important in mediating the endothelial response to vasodilators such as bradykinin and acetylcholine [11]. However, only inhibitory effects have been observed thus far, of which there is evidence in polymorphonuclear leucocytes [12] and in platelets [13], whereas we are suggesting that prilocaine might stimulate the endothelium to produce NO. Furthermore, this mechanism is just one potential explanation and we cannot rule out the possibility of interaction further down the endothelial pathway.…”

Section: Discussionmentioning

confidence: 83%

Mechanisms contributing to the vaso‐active effects of prilocaine in human skin

Newton

Sur²,

Khan

et al. 2002

Anaesthesia

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We investigated the roles of the endothelial nitric oxide and cyclo-oxygenase pathways in mediating the vasoactivity of prilocaine in the skin. We injected prilocaine 1% intradermally into forearm skin of 10 healthy, male subjects. Nitric oxide synthesis was inhibited at a second site by co-injecting prilocaine with l-NAME 1%. We then repeated the injections while blocking the cyclo-oxygenase pathway with aspirin (4 x 600 mg). We measured blood flow responses to the injections using laser Doppler imaging. We found that, after the traumatic effects of injection had subsided, l-NAME reduced the vascular response to prilocaine by a third (p = 0.012), indicating an influence specifically on the drug response. Aspirin had no effect on the response (p = 0.588). We conclude that the vasoactive effects of prilocaine in human skin are mediated partly through the release of endothelial nitric oxide and, although other mechanisms might also be involved, the cyclo-oxygenase pathway does not appear to play a role.

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Section: Discussionmentioning

confidence: 83%

Mechanisms contributing to the vaso‐active effects of prilocaine in human skin

Newton

Sur²,

Khan

et al. 2002

Anaesthesia

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“…21 Similarly, LAs attenuate hypercoagulable states, as shown in studies of their effects on postoperative thrombosis 22 and coagulation. 23 The inflammatory and hemostatic systems are closely interwoven, 24 and some of these actions may result from similar or identical mechanisms. Many of the critical mediators in these systems act through GPCRs.…”

Section: Na Channel-independent Effects Of Lasmentioning

confidence: 99%

“…As mentioned, a similar situation exists with their effects on coagulation: LAs attenuate the hypercoagulable state, such as exists after surgery, but do not interfere with normal coagulation (i.e., they do not induce bleeding). 23 We will discuss the putative mechanism behind this selective action, but at this point we will only note that the ability to separate these actions from Na channel block might yield a class of extraordinarily useful drugs.…”

Section: Na Channel-independent Effects Of Lasmentioning

confidence: 99%

Ca-signaling G-protein[ndash ]coupled receptors: A new site of local anesthetic action?

Hollmann

2001

Regional Anesthesia and Pain Medicine

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“…Місцеві анестетики надають пряму протизапальну дію як в місці блокади, так і за рахунок резорбтивної дії [109]. Причому місцеві анестетики, за наявними даними, селективно інгібують тільки надмірну активність прозапальних і гемостатичних систем, не порушуючи адаптивних реакцій [109,110].…”

Section: анестезіологічне забезпечення при хірургічному лікуванні сдсunclassified

“…Позитивний вплив регіонарних блокад на прояви операційного стресу і перебіг післяопераційного періоду показаний багатьма дослідженнями [109][110][111]. Симпатична блокада кінцівки, що анестезується, призводить до істотного (у 2-3 рази) поліпшення мікроцир куляції, при якому міжтканинна рідина активно переміщається в просвіт лімфатичних капілярів.…”

Section: анестезіологічне забезпечення при хірургічному лікуванні сдсunclassified

Mini-invasive methods of treatment of diabetic foot pain

Dmytriiev

Lysak

Glazov³

et al. 2019

PMJUA

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Neuropathic pain occurs with diabetic polyneuropathy more often than with all polyneuropathies of another etiology. Because the cause of pain can rarely be cured, treatment is usually symptomatic. Neuropathic pain is usually poorly controlled by analgesics. Management of neuropathic pain is started with conservative pharmacotherapy before invasive pain management is applied. Although there are many drugs that can be used in patients with diabetic pain syndrome, pain syndrome can not be surely stoped with monotherapy. In addition, the patient may not tolerate the full therapeutic dose of the drug. All this dictates the need for combination therapy. It is believed that regional anesthesia as an independent type of analgesia or a component of combined anesthesia is the method of choice for the elderly and senile patients. The main reasons for this choice, when comparing regional anesthesia with narcosis, are less stressful response of the organism, absence of depression of the central nervous system, stable reliable analgesia with complete blockade of nociceptive reflexes with the provision of adequate muscle relaxation, prevention of neurovegetative reactions, which ultimately helps to reduce the incidence of postoperative complications and mortality. Clinicians have accumulated considerable experience demonstrating the need for regional analgesia in the management of diabetic foot pain.

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Epidural Anesthesia Prevents Hypercoagulation in Patients Undergoing Major Orthopedic Surgery

Cited by 63 publications

References 17 publications

Mechanisms contributing to the vaso‐active effects of prilocaine in human skin

Mechanisms contributing to the vaso‐active effects of prilocaine in human skin

Ca-signaling G-protein[ndash ]coupled receptors: A new site of local anesthetic action?

Mini-invasive methods of treatment of diabetic foot pain

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