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    Diluted Epinephrine Injection Helps Reduce Blood Loss in Primary TKA

    In this study, patients who received topical tranexamic acid plus diluted epinephrine had a significantly lower total blood loss, hidden blood loss, and transfusion rate than patients who received topical tranexamic acid alone.

    Authors

    Jason P. Hochfelder, MD, and William J. Long, MD

    Article

    Gao F, Sun W, Guo W, et al. Topical administration of tranexamic acid plus diluted-epinephrine in primary total knee arthroplasty: a randomized double-blinded controlled trial. J Arthroplasty. 2015; Mar 14. pii: S0883-5403(15)00172-2. doi: 10.1016/j.arth.2015.03.003

    Summary

    In a double-blind, randomized controlled trial, tranexamic acid plus diluted-epinephrine was shown to reduce blood loss significantly more than tranexamic acid alone.

    The researchers randomly assigned 100 consecutive patients undergoing primary total knee replacement to receive either intra-articular tranexamic acid plus diluted-epinephrine or tranexamic acid alone. An injection was given intraoperatively after closure of the fascia with either 3 grams of tranexamic acid alone or 3 grams of tranexamic acid plus 0.25 mg of diluted epinephrine.

    There were no differences between the groups in preoperative demographics or characteristics. Perioperative details, such as tourniquet time, length of stay, range of motion, and time to straight leg raise, did not differ between groups.

    Patients who received topical tranexamic acid plus diluted epinephrine had significantly lower total blood loss (P = 0.006), hidden blood loss (P = 0.000), and transfusion rate (0% vs. 4%) compared with patients who received topical tranexamic acid alone. Patients who received diluted epinephrine did not have an increased complications rate compared with those patients who did not receive the drug.

    Clinical Relevance

    Reduction of blood loss associated with total knee arthroplasty has been shown to decrease postoperative cardiovascular complications and the need for allogeneic blood transfusions. A novel, low-cost method of reducing blood loss that does not increase complications such as thromboembolism would be a welcome addition to the arthroplasty surgeon’s armamentarium.

    Diluted epinephrine plus tranexamic acid injection may be the answer. As shown in this study, the combination of drugs may lead to lower rates of allogeneic blood transfusions, which have been shown to be associated with increased periprosthetic joint infections.

    While this is a well-designed randomized control, double-blind study, a larger multicenter study must be undertaken before the study protocol can be adopted as the gold standard.

    Author Information

    Jason P. Hochfelder, MD, is an Adult Reconstruction Fellow with the ISK Institute and NYU Langone Medical Center – Hospital for Joint Diseases, New York, New York. William J. Long, MD is an Attending Orthopaedic Surgeon with the ISK Institute and Clinical Associate Professor of Orthopaedic Surgery, Division of Adult Reconstruction, Department of Orthopaedic Surgery, at NYU Langone Medical Center – Hospital for Joint Diseases, New York, New York.