Deliberate hypotension in orthopedic surgery reduces blood loss and transfusion requirements: A meta-analysis of randomized controlled trials

Abstract

Purpose: To determine if deliberate hypotension decreases blood loss and transfusion requirements in patients undergoing orthopedic surgery, a systematic review of all randomized trials addressing this issue was undertaken.Methods: Electronic databases, citations lists and review articles were searched for potential articles. Relevant articles met the following inclusion criteria: English language, humans undergoing orthopedic surgery, deliberate hypotension used by any method, intraoperative blood loss measured as an outcome, and the trial methodology being randomized and controlled. Four outcomes were analyzed, including estimated blood loss, blood transfused, surgery duration, and quality of the surgical field. For all analyses, the random-effects model was used.Results: Seventeen articles met the inclusion criteria. The surgeries studied included total hip arthroplasty (seven), orthognathic surgery (eight), total knee arthroplasty (one) and spinal fusion (one). A total of 636 patients were randomized across all studies. For blood loss, the overall weighted mean difference favoured treatment, with a savings of about 287 mL of blood [95% confidence interval (CI): -447, -127]. The mean differences also showed a statistically significant benefit for deliberate hypotension in reducing transfusion requirements (-667 mL of blood transfused; 95% CI: -963, -370). Deliberate hypotension was not shown to reduce the duration of surgery (-1.9 min of surgery; 95% CI: -7.2, 3.5) or improve surgical conditions (surgical field quality rating -0.5; 95% CI: -1.1, 0.2). Conclusion:This review provides some support for the use of deliberate hypotension in reducing blood loss and transfusion requirements in orthopedic surgery, but these results are tempered by the small sample sizes and poor methodological quality of published studies.

Effect of induced hypotensive anaesthesia vs isovolaemic haemodilution on blood loss and transfusion requirements in orthognathic surgery: a prospective, single-blinded, randomized, controlled clinical study

“…1-3), which confirms its effectiveness in orthognathic surgery 6,15,19,[26][27][28] . No further blood-sparing effect was achieved by the additional use of isovolaemic haemodilution.…”

“…transmission of infectious diseases, immunosuppression, and haemolytic reactions as well as processing and administration errors) 10,14,31 . Previous reports have demonstrated that induced hypotension is safe and effective in reducing intraoperative blood loss, but no prospective data are available on the simultaneous application of induced hypotensive anaesthesia and isovolaemic haemodilution in orthognathic surgery 4,26 .…”

Regional Anesthesia Techniques in Orthopedic Surgery

“…However, it is unclear if the risk for neurologic complications is comparable between central neuraxial techniques and peripheral techniques [29][30][31]. Previous studies evaluating perioperative nerve injury (PNI) have some limitations including the lack of a standardized definition for PNI, the inclusion of patients undergoing a broad range of surgical procedures, the assessment of specific surgical procedural factors, the assessment of patient-related risk factors and the variability in which PNI was assessed [32]. Jacob et al [33] aimed to test the hypothesis that the use of regional anesthesia increases the risk for PNI after elective THA in a single-institution, largescale, single-procedural cohort study.…”

Réduction des transfusions sanguines allogènes grâce à un protocole basé sur le risque dans les cas d’arthroplastie avec prothèse totale

“…Several therapeutic interventions reduce the need for ABT in TJA, for example, measures to increase available red cell mass prior to surgery, either by the administration of iron 4 or erythropoietin 5 or by preoperative autologous blood donation; 6 measures to reduce surgical blood loss by hemodilution, 7 induced hypotension 8 or the use of antifibrinolytic agents; 9 and measures to make shed blood available for re-transfusion. 10 All of these measures have advantages and disadvantages in effectiveness, cost, risk, and convenience, and none has been proven to be completely superior to any other in every respect.…”