Hemostatic Role of Local Anesthetic Techniques in Major Orthopedic Joint Surgery: Mechanisms, Adjuvants, and Clinical Applications. A Narrative Review

Rabe Altomi; Mesad Ghula; Ayoub Dhu; Abdulwhab Almahroug; Fadia Oshkondale

doi:10.54361/ajmas.269809

Authors

Rabe Altomi Academic Surgical Department, Faculty of Medicine, University of Zawia, Libya https://orcid.org/0009-0008-7893-570X
Mesad Ghula Academic Surgical Department, Faculty of Medicine, University of Zawia, Libya https://orcid.org/0009-0003-2269-6619
Ayoub Dhu Academic Surgical Department, Faculty of Medicine, University of Zawia, Libya https://orcid.org/0000-0001-9004-2308
Abdulwhab Almahroug Academic Surgical Department, Faculty of Medicine, University of Zawia, Libya https://orcid.org/0009-0008-8427-9913
Fadia Oshkondale Pharmacological Department, Faculty of Medicine, University of Zawia, Libya https://orcid.org/0009-0008-2792-2343

DOI:

https://doi.org/10.54361/ajmas.269809

Keywords:

Local Anesthesia, Intraoperative Hemostasis, Total Joint Arthroplasty, Ropivacaine, Local Infiltration Analgesia

Abstract

Intraoperative joint bleeding during major orthopedic surgeries, particularly total joint arthroplasty (TJA) and arthroscopic procedures, represents a clinically significant challenge that prolongs operative time, obscures the surgical field, and increases the risk of postoperative complications, including hematoma and the need for blood transfusion. Although systemic antifibrinolytics such as intravenous Tranexamic acid (TXA) remain the standard of care, local anesthetic (LA) techniques are increasingly recognized for their direct modulatory effects on surgical site microvasculature. This narrative review examines the pharmacological mechanisms, comparative hemostatic profiles, and synergistic potential of key local anesthetic delivery techniques, including Local Infiltration Analgesia (LIA), peripheral nerve blocks (PNBs), neuraxial anesthesia, and intra-articular injections, in reducing intraoperative joint bleeding.