Reactionary haemorrhage reduction with adrenaline infiltration in proximal tibial osteotomy: a randomized clinical study of safety and efficacy

Abstract

In corrective osteotomy, wound closure is undertaken with or without deflation of the tourniquet. Hypoxia from the tourniquet causes vasodilatation associated with reactionary haemorrhage and reduced haemoglobin concentration and possibly increased blood transfusion rate. Reactionary haemorrhage and related transfusion need can be reduced through vasoconstriction from adrenaline infiltration. A randomized, placebo-controlled trial was done to compare adrenaline-saline solution to normal saline in the control of reactionary haemorrhage after proximal tibial osteotomy in children. Sixty-one eligible patients were divided into two groups and had corrective osteotomy under the same surgeon over a period of 7 years. Wound infiltration with adrenaline-saline solution 1:200,000 and normal saline was done in groups one and two, respectively. No intra-operative adverse effect was recorded. There was a 20% incidence of superficial wound dehiscence in group 1 and none in controls. The mean volume of blood in drains in the first 24 h post operation was 85 ml in group 1 and 225 ml in group 2 (p < 0.001). The mean haemoglobin level on the fifth day post operation was 11.8 g/dl in group 1 and 8.2 g/dl in group 2 (p < 0.001). There was no blood transfusion in group one while two patients were transfused in group two. In conclusion, wound infiltration with adrenaline was effective in reducing the extent of reactionary haemorrhage and post-operative drop in haemoglobin concentration. There was no significant difference in the transfusion rates in both groups.