Abstract
BackgroundReducing tourniquet inflation time is important because of the complications of tourniquet extensively used for the control of hemorrhage in total knee arthroplasty (TKA). Bleeding management is critical to acquire a relative bloodless arthrotomy interface for maximize cement fixation in non-tourniquet TKA. The purpose of this study was to investigate hemostatic and hemodynamic effects of epinephrine-soaked gauzes in cemented TKAs.MethodsA retrospective cohort study of 101 patients in two groups was performed. The first group (n = 51) underwent unilateral TKA with our procedures of epinephrine use, the second group (n = 50) had the same protocol with tourniquet and no epinephrine utilization. Surgical field visualization was assessed by grading scale for difficulty of intraoperative visualization due to blood and number of surgical field clearances. Perioperative blood loss was recorded. Hemodynamic parameters were observed in the epinephrine group.ResultsThere was statistically significant difference (p < 0.01) on surgeon-rated difficulty in visualization in the epinephrine group between before and after use of epinephrine, and no statistically significant difference (p = 0.96) between two groups before cementing. No statistically significant result on numbers of surgical field clearances between two groups (p = 0.25) was found. Epinephrine group showed significant difference in hidden blood loss compared with no epinephrine group (576.6 ± 229.3 vs 693.2 ± 302.9, respectively, p = 0.04). The hemodynamic effects of epinephrine may be under control.ConclusionThe procedure of epinephrine soaked gauzes, as a prudent adjunct, may be effective to reduce blood loss and obtain bloodless bone sections in non-tourniquet TKAs, regardless of hemodynamics.
Highlights
Reducing tourniquet inflation time is important because of the complications of tourniquet extensively used for the control of hemorrhage in total knee arthroplasty (TKA)
Epinephrine is often used in local infiltration analgesia to reduce systemic absorption of the local anesthetic and prolong the analgesic effect in total knee arthroplasty (TKA) [1,2,3], and is used to reduce perioperative blood loss [4, 5]
We found that ideal bloodless visualization of the operative field was obtained in the epinephrine group, comparing that in epinephrine group between before and after use of epinephrine and in two groups prior to cementing
Summary
Reducing tourniquet inflation time is important because of the complications of tourniquet extensively used for the control of hemorrhage in total knee arthroplasty (TKA). The purpose of this study was to investigate hemostatic and hemodynamic effects of epinephrine-soaked gauzes in cemented TKAs. Epinephrine is often used in local infiltration analgesia to reduce systemic absorption of the local anesthetic and prolong the analgesic effect in total knee arthroplasty (TKA) [1,2,3], and is used to reduce perioperative blood loss [4, 5]. Further research has showed that platelet count increases arise from splenic autotransfusion following low-dose epinephrine infusion via alphaadrenergic receptors [6,7,8]. There has been little discussion about its hemostatic effect as a vasoconstrictor, and hemodynamic effect from administration of epinephrine in TKA procedure
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