Epinephrine hydrochloride prevents bone cement implantation syndrome in cemented hip replacement

Abstract

Objective To investigate the clinical application of epinephrine hydrochloride in the prevention of bone cement implantation syndrome in the cemented hip replacement. Methods The clinical data of 48 patients treated with cemented hip replacement from July 2008 to April 2009 were retrospectively analyzed. All the patients were divided into control group and intervention group. The bone marrow cavities of 24 patients in the control group were not pretreated with saline epinephrine hydrochloride before implantation of bone cement; the bone marrow cavities of 24 patients in the intervention group were pretreated with saline epinephrine hydrochloride before implantation of bone cement. Systolic blood pressure （SBP）, diastolic blood pressure （DBP）, the mean arterial pressure （MAP）, heart rate （HR）and pulse oxygen saturation （ SPO2 ） were compared between the two groups before bone cement implantation and 1,2, 3, 4, 5, 6, 7, 8, 9, 10 minutes after bone cement implantation. The data were analyzed with variance analysis and Q test. Results （1） In the control group： the blood pressure was decreased in control group one minute after bone cement implantation and a significant decrease of the blood pressure was observed at 2-6 minutes after the implantation （ P 〈 0. 01 ）. The blood pressure was increased seven minutes after the implantation, with the most significant increase of DBP （ P 〈 0.05 ）.The blood pressure recovered to normal 10 minutes later. The SPO2 was decreased significantly （ P 〈0.05 ） but no significant change was observed in HR （ P 〉 0.05）. （2） In the intervention group： the bone marrow cavity was pretreated with saline epinephrine hydrochloride before implantation of bone cement.ity. No significant difference was found in SBP, DBP, MAP, HR and SPO2 at different time points before and after bone cement implantation （P 〉0.05 ）. Significant decrease of blood pressure and SPO2 was observed in control group and a significant hemodynamic change was detected at 2-6 minutes after the bone cement implantation. In the intervention group, no hemodynamic change was found in all the patients except that one patient was found with decrease of blood pressure and another one with the occasional premature ventricular contractions. Conclusion Pretreatment of bone marrow cavity with saline epinephrine hydrochloride can effectively prevent bone cement implantation syndrome. Key words: Arthroplasty, replacement, hip ; Epinephrine ; Bone cement implantation syndrome