What are the effects of regional anesthesia after Platelet-rich plasma (PRP) injection?

From the Guidelines

Regional anesthesia after PRP injections is not recommended due to the potential risk of bleeding and interference with the therapeutic effects of PRP treatment. The use of regional anesthesia in patients with abnormalities of coagulation, such as those who have received PRP injections, is a complex issue that requires careful consideration of the risks and benefits 1. According to the guidelines published by the Association of Anaesthetists of Great Britain and Ireland, an abnormality of coagulation is always a relative contraindication to the use of a regional anesthetic technique 1.

The guidelines suggest that experienced clinicians should be involved in decisions about whether or not to perform a regional anesthetic technique on a patient with abnormal coagulation, and the patient with capacity should be given all the information they need to make an informed choice 1. The risk of bleeding associated with regional anesthesia in patients with abnormalities of coagulation is difficult to quantify, but it is likely to be small 1. However, the potential consequences of bleeding, such as spinal hematoma, can be severe and long-lasting 1.

If pain management is needed following a PRP injection, alternative options such as acetaminophen (500-1000mg every 6 hours as needed) or short-term use of narcotic pain medications may be considered 1. NSAIDs such as ibuprofen or naproxen should be avoided for at least 2 weeks after PRP as they can interfere with the inflammatory process essential for healing. Patients should also be advised to limit activity involving the treated area for 24-48 hours after the injection to allow the PRP to work effectively.

In terms of specific guidance, the Association of Anaesthetists of Great Britain and Ireland recommends that regional anesthesia be avoided in patients with severe coagulopathy, and that alternative methods of pain management be used instead 1. For patients with mild or moderate coagulopathy, the decision to use regional anesthesia should be made on a case-by-case basis, taking into account the individual patient's risk factors and the potential benefits of the procedure 1.

Key points to consider when deciding whether to use regional anesthesia in a patient with abnormal coagulation include:

• The severity of the coagulopathy
• The patient's overall health status
• The potential benefits of the procedure
• The availability of alternative methods of pain management
• The patient's preferences and values

Ultimately, the decision to use regional anesthesia in a patient with abnormal coagulation should be made by an experienced clinician, in consultation with the patient and other relevant healthcare professionals, and should take into account the latest available evidence and guidelines 1.

From the Research

Regional Anesthesia After PRP Injection

• Regional anesthesia has a strong role in minimizing post-operative pain, decreasing narcotic use and PONV, and speeding discharge times 2
• However, regional anesthesia has both benefits and risks, including complications such as block failure, bleeding/hematoma, neurological injury, and local anesthetic toxicity 2
• The use of local anesthetics to prevent pain during PRP injections could compromise the therapeutic potential of PRP, as they can decrease platelet functionality 3
• The association of local anesthetics with PRP injections resulted in a significant decrease of platelets functionality, assessed by their capacity of aggregating 3
• Local anesthetics did not interfere with the growth factor release, but the use of local anaesthetics or limiting their use as often as possible is recommended 3
• Regional anesthesia, such as lumbar epidural and spinal anesthesia, may offer clinical advantages over general anesthesia, including reduced frequency of deep vein thrombosis and pulmonary embolism 4
• The effects of local anesthetics on leukocytes, platelets, erythrocytes, and plasma proteins and on the interactions among various blood cells and endothelial cells may also play a role in the protection against thromboembolism 4

Platelet-Rich Plasma (PRP) Therapy

• PRP is a therapeutic option used to treat many medical conditions, including musculoskeletal maladies, and has been shown to be safe 5, 6
• However, evidence of its efficacy has been mixed and highly variable depending on the specific indication 6
• The heterogeneity of PRP preparations has made interpreting existing literature more complicated and sweeping recommendations about its utility impossible to make 6