Reduced Blood Loss and Transfusion Rates: Additional Benefits of Local Infiltration Anaesthesia in Knee Arthroplasty Patients

Bhutta, M.A.; Ajwani, Sanil H.; Shepard, G.J.; Ryan, William G.

doi:10.1016/j.arth.2015.05.025

Cited by 20 publications

(24 citation statements)

References 21 publications

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“…Careful hemostasis and techniques that have been proved to lower the perioperative amount of blood loss (local infiltration of anesthesia and tranexamic acid use) can also contribute to lowering the transfusion rate. 23 , 24 …”

Section: Discussionmentioning

confidence: 99%

Predictors of blood transfusion following total knee replacement at a tertiary care center in Central Saudi Arabia

Alturki

Alaraifi

Badakhan

et al. 2017

SMJ

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Objectives:To examine the incidence and predictors of blood transfusion following total knee replacement (TKR).Methods:A retrospective study on 462 patients of primary TKR at National Guard Hospital, Riyadh, Kingdom of Saudi Arabia. Descriptive statistics were compared by blood transfusion status and significant variables were further included in the multivariable model.Results:Overall transfusion rate following TKR was 35.3%. Regression analyses identified bilateral surgery, low preoperative hemoglobin (Hb) level, and high amount of blood loss as predictors of blood transfusion.Conclusion:Correction of Hb level prior to surgery, careful hemostasis, and avoiding bilateral surgery may reduce the rate of blood transfusion following TKR.

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Section: Discussionmentioning

confidence: 99%

Predictors of blood transfusion following total knee replacement at a tertiary care center in Central Saudi Arabia

Alturki

Alaraifi

Badakhan

et al. 2017

SMJ

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“…We avoided gastrointestinal complications such as nausea and vomiting by minimizing opioids, using preventive methods such as aprepitant, 21 dexamethasone, 22 and scopolamine patch, 23 and by implementing a nutrition protocol that allows clear liquids until 2h before surgery and encourages rapid postoperative oral feeding. 24 Anemia was minimized by preoperative screening 25 and perioperative blood saving interventions (tranexamic acid, 26 adrenaline in LIA, 27 and postoperative knee exion 28 ).…”

Section: Complicationsmentioning

confidence: 99%

Improved Clinical Outcomes of Outpatient Enhanced Recovery Hip and Knee Replacements in Comparison to Standard Inpatient Procedures: A Study of Patients Who Experienced Both

Hardy

Courgeon

Pelleï

et al. 2021

Preprint

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BACKGROUND: The benefits of combining enhanced recovery after surgery (ERAS) interventions with an outpatient program for total hip/knee arthroplasty (THA/TKA) are uncertain. The primary objective was to compare adverse event rate and secondly to compare pain management, functional recovery, PROMs and satisfaction in patients who experienced both an ERAS-outpatient protocol and standard-inpatient care.METHODS: We conducted an ambidirectional single subject cohort study on 48 consecutive patients who experienced both a standard-inpatient and an ERAS-outpatient THA/TKA (contralaterally). We compared complications according to Clavien-Dindo scale and Comprehensive Complications Index (CCI), and unplanned episodes of care. Postoperative pain assessed with a numeric rating scale, opioid consumption in morphine milligram equivalents, functional recovery, patient-reported outcome measures (WOMAC, KOOS, HOOS, Forgotten Joint Score and Patient Joint Perception) and patients’ satisfaction were also evaluated.RESULTS: Following the ERAS-outpatient surgery, complication rates were reduced by more than 50% (2.1 vs 4.4, p<0.001), CCI was significantly lower (12.3 vs 19.1, p<0.001), and similar unplanned episodes of care were observed (p>0.999). In the first 8 postoperative hours, perceived pain was similar (p>0.805) while opioid consumption was significantly reduced (9.3 vs 26.5, p<0.001). Patients walked, climbed stairs, showered, performed activities of daily living, practised sports, went back to work sooner (p<0.001), but PROMs were similar between groups at the last follow-up (p> 0.188). Patients were more satisfied of the ERAS-outpatient pathway and recommended it significantly more (p <0.002). CONCLUSION: Compared to the conventional inpatient care, our ERAS-outpatient protocol proved to be safer, enable faster functional recovery, and improve patients’ satisfaction which highlight the importance of following ERAS principles when implementing an outpatient THA/TKA program.

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“…All the surgeries were performed through medial parapatellar approach by the corresponding author (Xisheng Weng) with 250 mmHg tourniquet under general anaesthesia. The constituent of administered cocktail solution in our study combined the components in previous studies [19][20][21][22], consisting of 200 mg ropivacaine, 100μg fentanyl, 0.25 mg adrenaline, 50 mg flurbiprofen axetil, and 1 mg diprospan, with addition of normal saline to a 60 mL soliton. A drainage tube was placed laterally to the prosthesis components in every joint, clamped for 3 h [23] and then unlocked, and removed in the second morning after surgery.…”

Section: Interventions Proceduresmentioning

confidence: 99%

The analgesic efficacy and safety of peri-articular injection versus intra-articular injection in one-stage bilateral total knee arthroplasty: a randomized controlled trial

et al. 2020

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Background: As an essential component of multimodal analgesia approaches after total knee arthroplasty (TKA), local infiltration analgesia (LIA) can be classified into peri-articular injection (PAI) and intra-articular injection (IAI) according to administration techniques. Currently, there is no definite answer to the optimal choice between the two techniques. Our study aims to investigate analgesic efficacy and safety of PAI versus IAI in patients receiving simultaneous bilateral TKA. Methods: This randomized controlled trial was conducted from February 2017 and finished in July 2018. Sixty patients eligible for simultaneous bilateral total knee arthroplasty were randomly assigned to receive PAI on one side and IAI on another. Primary outcomes included numerical rating scale (NRS) pain score at rest or during activity at 3 h, 6 h, 12 h, 24 h, 48 h, and 72 h following surgery. Secondary outcomes contained active or passive range of motion (ROM) at 1, 2, and 3 days after surgery, time to perform straight leg raise, wound drainage, operation time, and wound complications. Results: Patients experienced lower NRS pain scores of the knee receiving PAI compared with that with PAI during the first 48 h after surgery. The largest difference of NRS pain score at rest occurred at 48 h (PAI: 0.68, 95%CI[0.37, 0.98]; IAI: 2.63, 95%CI [2.16, 3.09]; P < 0.001); and the largest difference of NRS pain score during activity also took place at 48 h (PAI: 2.46, 95%CI [2.07, 2.85]; IAI: 3.90, 95%CI [3.27, 4.52]; P = 0.001). PAI group had better results of range of motion and time to perform straight leg raise when compared with IAI group. There were no differences in operation time, wound drainage, and wound complication. Conclusion: PAI had the superior performance of pain relief and improvement of range of motion to IAI. Therefore, the administration technique of peri-articular injection is recommended when performing local infiltration analgesia after total knee arthroplasty. Trial registration: The trial was retrospectively registered in the Chinese Clinical Trial Registry as ChiCTR1800020420 on 29th December, 2018.

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Reduced Blood Loss and Transfusion Rates: Additional Benefits of Local Infiltration Anaesthesia in Knee Arthroplasty Patients

Cited by 20 publications

References 21 publications

Predictors of blood transfusion following total knee replacement at a tertiary care center in Central Saudi Arabia

Predictors of blood transfusion following total knee replacement at a tertiary care center in Central Saudi Arabia

Improved Clinical Outcomes of Outpatient Enhanced Recovery Hip and Knee Replacements in Comparison to Standard Inpatient Procedures: A Study of Patients Who Experienced Both

The analgesic efficacy and safety of peri-articular injection versus intra-articular injection in one-stage bilateral total knee arthroplasty: a randomized controlled trial

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