Anesthesia and hemostasis in orthopedic surgery: the impact of anesthetic management on bleeding control

Abstract

Anesthetic management plays a crucial role in controlling bleeding during orthopedic surgery, influencing factors such as platelet aggregation, coagulation cascades and hemodynamic stability. Different anesthetic techniques, such as regional blocks and general anesthesia, have varying impacts on hemostatic mechanisms and are essential for optimizing perioperative safety and outcomes. This study was conducted as an integrative review. A systematic search was carried out in the PubMed, BMC Anesthesiology and European Journal of Clinical Pharmacology databases, using the descriptors anesthesia, hemostasis, orthopedic surgery, hemorrhage. Articles published between 2015 and 2024 and written in English, Portuguese or Spanish were included. The inclusion criteria focused on studies that addressed anesthetic techniques and bleeding control, while duplicate or out-of-scope publications were excluded. Methodological quality was assessed using the PRISMA tool. The studies reviewed highlighted that regional techniques, such as peripheral blocks, are associated with lower intraoperative blood loss due to reduced blood pressure and inflammatory response. Volatile anesthetics such as sevoflurane showed a negative impact on platelet aggregation, while intravenous agents such as propofol showed neutral effects. Multimodal strategies combining general anesthesia and regional blocks proved effective in controlling bleeding and preventing thromboembolic complications. Patients with coagulopathies required individualized anesthetic planning, with continuous monitoring of coagulation and the use of technologies such as thromboelastography. Anesthetic management directly affects hemostatic outcomes in orthopedic surgery. Personalized techniques, combining regional and multimodal approaches, demonstrate greater efficacy in reducing blood loss and complications. Integration between anesthesiologists and surgical teams is essential to optimize safety and promote better perioperative outcomes.