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Does sympathetic blockade prevent the physiologic changes associated with tourniquet use in children?
M Goodarzi1, N H Shier, D P Grogan
1Department of Anesthesia, Shriners Hospital for Children, Tampa, Florida, USA.
Journal of Pediatric Orthopedics
|May 1, 1997
Summary
Sympathetic blockade using epidural bupivacaine effectively controlled physiologic changes during prolonged tourniquet use in pediatric orthopaedic surgery. This method minimized blood pressure, pulse rate, and temperature fluctuations compared to standard anesthesia.
Area of Science:
- Anesthesiology
- Pediatric Orthopaedics
- Pain Management
Background:
- Prolonged tourniquet application (> or = 50 min) in pediatric orthopaedic surgery can cause significant altered physiologic effects.
- Managing these effects is crucial for patient safety and optimal surgical outcomes.
- Current anesthetic techniques may not fully mitigate tourniquet-induced stress responses.
Purpose of the Study:
- To investigate the efficacy of sympathetic blockade via epidural bupivacaine in controlling physiologic changes during extended tourniquet times in children undergoing orthopaedic surgery.
- To compare the hemodynamic and temperature stability between patients receiving epidural bupivacaine and those receiving standard anesthesia.
- To assess the utility of thermography in confirming the sympathetic blockade.
Main Methods:
- A randomized controlled trial involving 40 pediatric patients undergoing orthopaedic surgery with tourniquet application > or = 50 min.
- Patients were randomized into two groups: a control group (nitrous/narcotic with inhalation anesthesia) and an intervention group (epidural bupivacaine with isoflurane supplementation).
- Sympathetic blockade in the intervention group was confirmed using thermography.
Main Results:
- The group receiving epidural bupivacaine demonstrated significantly fewer and minor physiologic changes compared to the control group.
- Key indicators such as blood pressure, pulse rate, and body temperature remained more stable in the sympathetic blockade group.
- Thermography successfully confirmed the presence and extent of the sympathetic blockade.
Conclusions:
- Epidural bupivacaine provides effective sympathetic blockade, significantly mitigating adverse physiologic effects associated with prolonged tourniquet use in pediatric orthopaedic surgery.
- This anesthetic approach enhances patient stability during lengthy procedures.
- Sympathetic blockade is a valuable strategy for managing tourniquet-induced stress in pediatric patients.