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Haemostatic changes caused by i.v. regional anaesthesia with lignocaine
T T Niemi1, A H Kuitunen, E M Vahtera
1Department of Anaesthesiology, Helsinki University Central Hospital, Finland.
British Journal of Anaesthesia
|June 1, 1996
Summary
Intravenous regional anaesthesia (IVRA) with lignocaine potentiates fibrinolysis, a blood clotting process. However, lignocaine did not worsen platelet dysfunction during this anaesthesia technique.
Area of Science:
- Anesthesiology
- Hematology
- Pharmacology
Background:
- Intravenous regional anaesthesia (IVRA) involves tourniquet compression and local anesthetics, potentially affecting blood clotting.
- Understanding the impact of local anesthetics like lignocaine on hemostatic mechanisms during IVRA is crucial.
Purpose of the Study:
- To investigate the role of lignocaine in IVRA on hemostatic variables, specifically fibrinolysis and platelet function.
- To compare the effects of lignocaine versus saline in IVRA on blood coagulation.
Main Methods:
- A crossover study was conducted on 10 healthy male volunteers.
- Blood samples were analyzed for fibrinolysis markers (D-dimer, t-PA, PAI, protein C) and platelet function (aggregation, beta-thromboglobulin, thrombelastogram).
- Subjects received either lignocaine or saline intravenously during IVRA.
Main Results:
- IVRA enhanced fibrinolysis, indicated by markers like D-dimer and t-PA.
- Lignocaine significantly increased tissue plasminogen activator antigen (t-PA antigen) and plasminogen activator inhibitor activity (PAI) compared to saline.
- Platelet function tests showed no significant differences between lignocaine and saline groups, with a slight improvement in fibrin-platelet interaction observed with lignocaine.
Conclusions:
- High concentrations of intravenous lignocaine potentiate ischemia-induced fibrinolysis activation during IVRA.
- Lignocaine does not aggravate the platelet dysfunction observed during IVRA.