Hypotensive epidural anesthesia in total knee replacement without tourniquet: Reduced blood loss and transfusion

Juelsgaard, Palle; Larsen, Ulf Tyge; Sørensen, Jesper Roed; Madsen, Frank; Søballe, Kjeld

doi:10.1053/rapm.2001.21094

Cited by 79 publications

(93 citation statements)

References 25 publications

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“…Although many factors may contribute to this finding, it could be explained by the higher level of preoperative hemoglobin in male patients compared with female patients as previously reported 14 . The role of regional anesthesia in reducing blood loss during total joint arthroplasty has been well defined 29,30 . When using spinal anesthesia, the blockade of preganglionic sympathetic nerves affects the vascular smooth muscles and leads to vasodilatation of arterioles, arteries, and veins.…”

Section: Discussionmentioning

confidence: 99%

Predictors of Perioperative Blood Loss in Total Joint Arthroplasty

Park

Rasouli

Mortazavi

et al. 2013

Journal of Bone and Joint Surgery

177

105

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Section: Discussionmentioning

confidence: 99%

Predictors of Perioperative Blood Loss in Total Joint Arthroplasty

Park

Rasouli

Mortazavi

et al. 2013

Journal of Bone and Joint Surgery

177

105

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“…transfusions include autologous blood transfusion [10,34,37], postoperative blood salvage [1,9,16,20,21,34,52], use of a femoral intramedullary plug [43], hypotensive anesthesia [30], cryotherapy and Jones bandage [18], use of fibrin tissue adhesive [33,58], drain clamping [41,42,45,46,48,51,54,59], and administration of tranexamic acid [6-8, 19, 23, 24, 27, 28, 35, 39, 53, 55].…”

mentioning

confidence: 99%

Tranexamic Acid Reduces Blood Loss and Blood Transfusion after TKA: A Prospective Randomized Controlled Trial

Charoencholvanich

Siriwattanasakul

2011

Clinical Orthopaedics &Amp; Related Research

138

105

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Background TKA may be associated with considerable blood loss, and transfusion carries substantial risk of immunologic reaction and disease transmission. Blood transfusion also involves additional cost, therefore a reduction in its use is important. Several methods reportedly reduce postoperative blood loss and avoid homologous blood transfusion with traditional TKA approaches, but it is unclear these reductions apply to a minimally invasive technique. Questions/purposes We asked whether tranexamic acid administration could reduce blood loss and blood transfusion requirements after TKA.

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“…The anesthetic challenges are numerous, as detailed by Molnar et al [13] in a study of 49 patients undergoing hemipelvectomy with massive blood loss and resulting in coagulopathy of primary concern. Hypotensive epidural anesthesia is a technique that uses an extensive epidural block and low-dose epinephrine infusion resulting in arterial hypotension but with preservation of central venous pressure, controlled heart rate, and cardiac output [9]. It has been shown to be effective in reducing blood loss in THA [10,15,[18][19][20].…”

Section: Discussionmentioning

confidence: 99%

“…Hypotensive epidural anesthesia is a technique already established in arthroplasty, where it has been shown to reduce blood loss and allogeneic transfusion use [9,15]. Hypotensive anesthesia has also been studied in spinal surgery and maxillofacial surgery where it has demonstrated reductions in blood loss and transfusion use when used in conjunction with antifibrinolytics and topical hemostasis [6].…”

Section: Discussionmentioning

confidence: 99%

“…Hemorrhagic hypovolemia resulting in allogeneic transfusion is associated with increased morbidity after nononcological surgery [8,9,12]. Allogeneic blood transfusions after oncological surgery may increase the risk of postoperative infection, and they may even increase the risk of cancer recurrence, perhaps an effect of immunosuppression and immune modulation [23].…”

Section: Introductionmentioning

confidence: 99%

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Hypotensive Epidural Anesthesia Reduces Blood Loss in Pelvic and Sacral Bone Tumor Resections

Freeman

Thorne

Gaston

et al. 2017

Clinical Orthopaedics &Amp; Related Research

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Background Resection of pelvic and sacral tumors can cause severe blood loss, complications, and even postoperative death. Hypotensive epidural anesthesia has been used to mitigate blood loss after elective arthroplasty, but to our knowledge, it has not been studied as an approach that might make resection of pelvic and sacral tumors safer. Questions/purposes The purposes of this study were (1) to compare the blood loss and blood product use for patients undergoing pelvic and sacral tumor surgery under standard anesthesia or hypotensive epidural anesthesia; (2) to assess the frequency of end-organ damage with the two techniques; and (3) to compare 90-day mortality between the two techniques. Methods Between 2000 and 2014, 285 major pelvic and sacral resections were performed at one center. A total of 174 (61%) had complete data sets for analysis of blood loss, transfusion use, complications, and mortality at 90 days. Of those, 102 (59%) underwent hypotensive epidural anesthesia, whereas the remainder received standard anesthetic care. The anesthetic approach was determined by the anesthetists in charge of the case with hypotensive epidural anesthesia exclusively performed by one of two subspecialty trained anesthetists as their routine for major pelvic or sacral surgery. The groups were comparable in terms of potential confounding variables such as age, gender, tumor volume, and operation performed. Hypotensive epidural anesthesia was defined as a technique using an extensive epidural block up to T2-3 dermatome, peripherally administered low-concentration intravenous adrenaline infusion, and using unimpeded spontaneous respiration to achieve controlled hypotension, precise rate control of the heart, and enhanced velocity of venous return, all aggregated thus to minimize blood loss during pelvic surgery while preserving vital perfusion. The groups were assessed for perioperative blood loss calculated from pre-and postsurgery hemoglobin and transfusion use as well as postoperative complications, morbidity, and mortality at 90 days. Results There was less mean blood loss in the hypotensive epidural anesthesia group (1457 mL, SD 1721, 95% confidence interval [CI], 1114-1801 versus 2421 mL, SD 2297, 95% CI, 1877-2965; p = 0.003). Patients in the hypotensive epidural anesthesia group on average received fewer packed red cell transfusions (2.7 units, SD 2.9, 95% CI, 2.1-3.2 versus 3.9 units, SD 4.4, 95% CI, 2.9-5.0; Each author certifies that he, or a member of his immediate family, has no funding or commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article. All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research1 editors and board members are on file with the publication and can be viewed on request. Each author certifies that his or her institution approved or waived approval for the human protocol for this investigation and that all in...

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Hypotensive epidural anesthesia in total knee replacement without tourniquet: Reduced blood loss and transfusion

Abstract: We conclude that HEA is a safe technique that allows TKR without a tourniquet. Compared with spinal anesthesia, the use of HEA for TKR significantly reduces blood loss and the need for blood transfusion.

Cited by 79 publications

References 25 publications

Predictors of Perioperative Blood Loss in Total Joint Arthroplasty

Predictors of Perioperative Blood Loss in Total Joint Arthroplasty

Tranexamic Acid Reduces Blood Loss and Blood Transfusion after TKA: A Prospective Randomized Controlled Trial

Hypotensive Epidural Anesthesia Reduces Blood Loss in Pelvic and Sacral Bone Tumor Resections

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