Perioperative blood management strategies for patients undergoing total knee replacement: Where do we stand now?

Themistoklis, Tzatzairis; Vogiatzaki, Theodosia; Kazakos, Konstantinos; Georgios, Drosos I

doi:10.5312/wjo.v8.i6.441

Cited by 65 publications

(72 citation statements)

References 168 publications

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“…The technique is also possible to significantly reduce postoperative pain Perioperative bleeding remains a severe issue in TKA, causing swelling, anaemia, and elevated blood transfusion rate. (7) Several measures have been used to reduce the bleeding incidence, blood loss volume and blood transfusion rate, including controlled hypertension, tourniquets, intraoperative intravenous/intra-articular tranexamic acid (TXA), and the application of cryotherapy after TKA, using the bandaging technique after TKA (8). TXA is an antifibrinolytic medication.…”

Section: Introductionmentioning

confidence: 99%

Percutaneous intra-articular injections of ropivacaine, and tranexamic acid and removal of the drainage tube one day after total knee arthroplasty as a component of enhanced recovery after surgery: a randomized control trial

Li-jia¹,

Li²,

Liu³

et al. 2020

Preprint

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Background: Intraoperative injections of ropivacaine and tranexamic acid have an increasing role as part of analgesia and haemostasis for enhanced recovery after Total Knee Arthroplasty. However, drug efficiency gradually disappears one day after surgery. Drainage tube placed for too long can cause various complications. This study evaluates whether the postoperative injections of ropivacaine, and tranexamic acid and removal of the drainage tube one day would promote recovery after TKA. Methods: A total of 80 participants were randomly assigned to two groups. One group was treated with additional intra-articular injections at 08:30 on postoperative day 1 and the removal of drainage tube simultaneously (Trial Group). Another group was dealt with no injection and removal of the drainage tube responding to the amount of drainage fluid (Control Group). The multi-drug solution included 100 mg ropivacaine, and 1 g tranexamic acid, and 10 mL saline. The primary outcomes assessed included visual analog scale score, length of hospital stay after surgery, the circumference of the knee, total blood loss volume. Results: The group that received an additional intra-articular injection of ropivacaine had a significantly lower area under the curve for visual analog scale score than the no injection group at rest (424 ± 32 compared with 515 ± 39, p = 0.003). The Trial Group can reduce the length of hospital stay after surgery over the Control Group (7.1 ± 3.1 days compared with 8.7 ± 3.2 days, p = 0.003). The group that received an additional intra-articular injection of tranexamic acid have no difference in total blood loss volume & the circumference of knee joint over the no additional intra-articular injection group (910.6 ± 385.3 mL compared with 974.8 ± 408.2 mL, p=0.47 & 38.9 ±5.4cm compared with 38.8±2.4cm，p=0.91). Conclusions: Intra-articular injection of ropivacaine, and tranexamic acid and removal of the drainage tube one day after TKA can further promote recovery after TKA. Keywords: enhanced recovery after surgery, total knee arthroplasty, tranexamic acid, ropivacaine

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Section: Introductionmentioning

confidence: 99%

Percutaneous intra-articular injections of ropivacaine, and tranexamic acid and removal of the drainage tube one day after total knee arthroplasty as a component of enhanced recovery after surgery: a randomized control trial

Li-jia¹,

Li²,

Liu³

et al. 2020

Preprint

View full text Add to dashboard Cite

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“…Based on the three PBM pillars, many individual elements can be combined to optimise the management of patients. Articles describing which elements can or should be implemented are numerous (Spahn, 2010;WHO, 2010;Goodnough & Shander, 2012;Shander et al, 2012;Isbister, 2013;Shander et al, 2013;Vaglio et al, 2016;Fullenbach et al, 2017;Kozek-Langenecker et al, 2017;Munoz et al, 2017;Themistoklis et al, 2017;Vaglio et al, 2017). However, no information or recommendations are provided on how to implement these elements in practice.…”

Section: Patient Blood Management Pillarsmentioning

confidence: 99%

Towards a systematic approach for (de)implementation of patient blood management strategies

Voorn

Bodegom‐Vos

So‐Osman

2018

Transfusion Medicine

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Despite the increasing availability of evidence in transfusion medicine literature, this evidence does not automatically find its way into practice. This is also applicable to patient blood management (PBM). It may concern the lack of implementation of effective new techniques or treatments, or it may apply to the (over)use of techniques and treatments (e.g. inappropriate transfusions) that have proven to be of limited benefit for patients (low-value care) and could be abandoned (de-implementation). In PBM literature, the implementation of restrictive transfusion thresholds and the de-implementation of inappropriate transfusions are described. However, most implementation strategies were not preceded by the identification of relevant barriers, and the used strategies were not often supported by literature on behavioural changes. In this article, we describe implementation vs de-implementation, highlight the current situation of (de)implementation in PBM and describe a systematic approach for (de)implementation illustrated by an example of a PBM de-implementation study regarding '(cost-) effective patient blood management in total hip and knee arthroplasty'. The systematic approach used for (de)implementation is based on the implementation model of Grol, which consists of the following five steps: the detection of improvement goals, a problem analysis, the selection of (de)implementation strategies, the execution of the (de)implementation strategy and an evaluation. Based on the description of the current situation and the experiences in our de-implementation study, we can conclude that de-implementation may be more difficult than expected as other factors may play a role in effective de-implementation compared to implementation.

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“…Autologous donation is associated with a > 1 g/dL drop in hemoglobin (Hgb), precipitating an iatrogenic anemia in many patients. 4 Not surprisingly, studies have shown that patients who choose to utilize autologous donation have an increased risk of all transfusions (autologous or allogenic). 5 It has also been reported that a considerable amount of preoperative donations is ultimately wasted.…”

Section: Autologous Blood Donationmentioning

confidence: 99%

Minimizing Blood Loss and Transfusions in Total Knee Arthroplasty

2018

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Blood loss management is critical to positive outcomes in patients undergoing total knee arthroplasty (TKA). Transfusions are associated with an increased risk of major and minor adverse events, length of hospitalization, and overall cost associated with surgery. Many techniques have been investigated and compared. Tranexamic acid (TXA), an antifibrinolytic drug widely known to reduce blood loss, may be a bridge to the goal of eliminating blood transfusions from TKA. Administration of TXA can be performed intravenously, topically at the knee joint, orally, or in combination. A single bolus or multiple doses have reduced total blood loss and transfusion rates consistently, safely, and cost-effectively. The uptake in use of TXA by surgeons has been slow due to concerns in patients deemed high risk for thromboembolic events. Newer evidence from studies specifically involving high-risk patients demonstrates that TXA is indeed safe in this cohort and provides benefits that greatly outweigh potential risks. Incorporation of TXA as a routine part of TKA is in the best interest of patients, health care teams, and medical institutions. TXA can be employed seamlessly with other blood saving techniques and has the capacity to increase productivity and decrease overall cost. This can be achieved by reducing the incidence of transfusion and length of stay, and the need for practices such as preoperative anemia treatment and suction drainage.

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Perioperative blood management strategies for patients undergoing total knee replacement: Where do we stand now?

Cited by 65 publications

References 168 publications

Percutaneous intra-articular injections of ropivacaine, and tranexamic acid and removal of the drainage tube one day after total knee arthroplasty as a component of enhanced recovery after surgery: a randomized control trial

Percutaneous intra-articular injections of ropivacaine, and tranexamic acid and removal of the drainage tube one day after total knee arthroplasty as a component of enhanced recovery after surgery: a randomized control trial

Towards a systematic approach for (de)implementation of patient blood management strategies

Minimizing Blood Loss and Transfusions in Total Knee Arthroplasty

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