Early Biochemical and Hemodynamic Changes after Operation in a Bloodless Field

Larsson, Jörgen; Lewis, David H.; Liljedahl, S.‐O.; Löfström, J. B.

doi:10.1159/000127950

Cited by 41 publications

(27 citation statements)

References 8 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…When norepinephrine was added to the saline solution, there was a greater haemostatic effect compared with the saline solution alone. The efficacy of norepinephrine is related to the peak of blood flow that is normally present for 20 -30 min after tourniquet release [5]. The local infusion of norepinephrine before releasing the tourniquet induces contraction of peripheral vessels, with a reduction of this peak.…”

Section: Discussionmentioning

confidence: 99%

Local infusion of norepinephrine reduces blood losses and need of transfusion in total knee arthroplasty

Gasparini

Papaleo

Pola

et al. 2006

International Orthopaedics (SICO

View full text Add to dashboard Cite

Blood loss after total knee arthroplasty (TKA) is often associated with cardiovascular complications and a high transfusion rate of allogenic blood. In our study we focused our attention on developing a new intra-surgical procedure that appears safe, easy to perform and effective in the reduction of bleeding in TKA. We evaluated 84 patients who underwent TKA and met our inclusion criteria; they were assigned to two groups: 55 controls in which a saline solution was used to wash the surgical field before tourniquet release, and a second group of 29 patients, in which a saline solution containing a low dose of norepinephrine was locally applied before tourniquet release. The local administration of a low dose of norepinephrine has induced a significant reduction of perioperative blood loss and blood transfusion requirements; in addition, this method was characterised by the absence of complications or adverse effects. In conclusion, our data suggest that intraoperative local administration of a low dose of norepinephrine could represent an effective and safe method of reducing blood loss and preventing blood transfusions in patients with TKA.

show abstract

Section: Discussionmentioning

confidence: 99%

Local infusion of norepinephrine reduces blood losses and need of transfusion in total knee arthroplasty

Gasparini

Papaleo

Pola

et al. 2006

International Orthopaedics (SICO

View full text Add to dashboard Cite

show abstract

“…After surgery, reactive blood flow increases, with the peak flow appearing within five minutes once the tourniquet is deflated (Larsson et al 1977). Most of the blood loss in TKA occurs during the first few postoperative hours.…”

Section: Effect Of Temporary Drain Clampingmentioning

confidence: 99%

The Role of Drainage After Total Knee Arthroplasty

Tai¹,

Yang²,

Chang³

2012

Recent Advances in Hip and Knee Arthroplasty

View full text Add to dashboard Cite

“…Larsson et al noted back in the 1970's that when a tourniquet is released there is an increased reactive blood flow to the limb. 30 This effect was found to peak 5 minutes after tourniquet release, though persisted for several hours. Wakankar et al reported that this reactive hyperaemia can contribute to limb swelling and increased soft tissue tension after a tourniquet release, which in turn may explain the increased wound pain that this group of patients feel.…”

Section: Discussionmentioning

confidence: 97%

A comparison of blood loss and the need for transfusion following primary total knee replacement with or without the use of a tourniquet

et al. 2018

View full text Add to dashboard Cite

INTRODUCTIONTotal knee replacement (TKR) is an extremely common operation with nearly 70,000 performed each year in the UK. 1 With an increasingly ageing population, demands for this surgical intervention are likely to rise. TKR has traditionally been carried out with the use of a tourniquet placed in a proximal thigh position and set to a pressure of 300 mmhg for either the entirety or part of the operation. The benefits of using a tourniquet are often quoted as a reduction in blood loss during the operation and a reduction in the operative time by allowing the surgeon a bloodless operative field.2,3 It is also thought to improve the cementing technique during prosthetic implantation as the bloodless field permits better penetration of cement into bone.4,5 However these presumptions have been questioned. ABSTRACTBackground: Primary total knee replacement (TKR) has traditionally been carried out with the use of a tourniquet. More recent trends towards performing the surgery without a tourniquet have had some support in the literature and may improve patient recovery. Methods: A retrospective cohort of 198 consecutive primary TKRs from our institution were identified and analysed, 52 used a tourniquet and 146 did not. All TKRs also utilised a standardised interventions protocol including withholding of anticoagulants and antiplatelet medications, topical adrenaline injection, and both IV and topical tranexamic acid. Outcomes measured were estimated intra-operative blood loss, overall blood loss through comparison of pre and post-operative haemoglobin laboratory values, and the need for post-operative blood transfusion. Results: Analysis demonstrated a statistically significant reduction in estimated intra-operative blood loss when a tourniquet was used (p<0.001). However, overall blood loss indicated by the haemoglobin drop after surgery was not significantly affected by tourniquet use (p=0.342). Transfusion requirements were also similar among the groups (4.8% vs. 5.8%) and no tendency was suggested towards an increased rate of transfusion in the non-tourniquet group. Conclusions: Our study shows that although estimated intra-operative blood loss is increased without a tourniquet, total blood loss as measured by haemoglobin levels is no different for primary TKRs that use a tourniquet and those that do not. Furthermore there is no difference in post-operative blood transfusion rates. It is our hope that this study will add to the body of evidence for surgeons to consider no longer using a tourniquet for primary TKR.

show abstract

Early Biochemical and Hemodynamic Changes after Operation in a Bloodless Field

Cited by 41 publications

References 8 publications

Local infusion of norepinephrine reduces blood losses and need of transfusion in total knee arthroplasty

Local infusion of norepinephrine reduces blood losses and need of transfusion in total knee arthroplasty

The Role of Drainage After Total Knee Arthroplasty

A comparison of blood loss and the need for transfusion following primary total knee replacement with or without the use of a tourniquet

Contact Info

Product

Resources

About