Anita Surana

Abstract

To compare the efficacies of intra-articular applications of tranexamic acid and adrenaline on postoperative bleeding after total knee arthroplasty. Introduction: Currently, total knee arthroplasty (TKA) is considered the treatment of choice in advanced stages of knee osteoarthritis. Despite advances in surgical and anaesthetic techniques, TKA is still associated with a considerable amount of perioperative blood loss. Tranexamic acid (TXA) is an antifibrinolytic drug whose administration during the perioperative period either by intravenous route or topically applied to the surgical field has been shown to reliably reduce blood loss and need for transfusion in patients undergoing total knee arthroplasty. Material and Method: The single-center, double-blind, controlled study was undertaken after approval from the institutional ethical committee. we included 60 pts in three groups of 20 pts each, Group A pts received 1000mg of tranexamic acid intra-articular and peri-articular, diluted with 10 ml Ns to make it 20 ml, Group B pts received 1000mg tranexamic acid +1 ml of 1:1000 Adrenalin + 9 ml of Ns and Group C pts received1 ml of 1:1000 Adrenalin diluted to 19 ml with Ns at the time of wound closure. We compared blood loss in all the three groups in first 24 hrs, and fall in Hb level from the preoperative level at 4hrs and 24 hrs. post-operatively. Also observed the no of blood transfusions required in all three groups in 48 hrs. Also noted any untoward effects like infection, deep vein thrombosis, etc. Results: Fall in Hb level was also less in Grp B (1.22±0.45), as compared to Grp A (1.56±0.3,) and Grp C (1.65±0.68) at 4 hrs. post-operative and it was statistically significant (P-value 0.0219). Total 24 hrs. fall in Hb was 2.14±0.31 in Grp A, 1.18±1.14 in Grp B, and 2.52±0.19in Grp C which was also statistically significant (P-value 0.005) The total blood loss in 24 hrs. is 324+-81.93ml in Grp B, 370±72.±72.6 ml in Grp A and410.30 ml in Grp C which was statistically significant (P value 0.005). The no of blood transfusion required in 48 hrs. is 5 Units in Grp C as compared to 3 units in Grp A and 2 units in Grp B. Conclusion We came to the conclusion that TXA given as local infiltration is an effective and safe method of preventing postoperative blood loss and the addition of Adrenaline as an adjuvant further adds to its effect without much untoward effect.   Keywords: Knee-Arthroplasty, Tranexamic acid, Adrenaline, Haemostasias, Blood loss.

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Abstract

Context: Local anaesthetic infiltration in knee and hip arthroplasty is employed as a part of multi-model analgesia to reduce opiate consumption and help in early ambulation of elderly people It reduces postoperative pain effectively and thus reduces complications like Deep vein thrombosis, pulmonary embolism, pneumonia and even myocardial infection. Addition of ketorolac or Tramadol further prolongs the duration of analgesia. Aims: To compare the local anaesthetic infiltration of Ropivacaine alone and Ropivacaine with Ketorolac and Ropivacaine with tramadol for postoperative pain relief in knee and hip arthroplasty. Materials and Methods: Randomize double-blind study was conducted on 60 patients undergoing knee or hip arthroplasty under spinal anaesthesia. Group A patients received wound infiltration with Inj. Ropivacaine0.75% 50ml (5-7 mg/kg), Group B patients received Inj. Ropivacaine 0.75% 50 ml+1ml Inj. Ketorolac(30 mg) and Group C patients received Inj Ropivacaine 0.75% 50 ml+ Inj Tramadol 2ml (100mg), all diluted with NS to make 100 ml infiltration. Post-operative pain scores, time of first rescue analgesia (FRA), hemodynamic parameters and total rescue analgesic consumed in 24 hrs. as Inj Diclofenac and Tramadol was assessed and any untoward incidences like nausea, vomiting, knee swelling & Hypotension etc. were noted. Results: The VA Score was significantly lower in Grp C as compared to Grp B and A in first 4-6 hrs. as tramadol and ketorolac significantly prolongs the duration of analgesia. VA score in Grp Cis 3.8+_0.52, as compared to 4.02 ±1.58 in Grp B and 5.7 ±1.014 in Grp A. which was statistically significant( P value 0.0141). The time of first rescue analgesia (FRA) was also prolonged by 2.2 hrs. in Grp C as compared to Grp B and C which is statistically significant .(P value 0.003).The total rescue analgesia in 24 hrs. given as Inj Diclofenac and Inj Tramadol was significantly lower in Grp C as compared to Grp B and A. No of pts requiring rescue analgesia was also less 45% in Grp C as compared to 50% and 95% in Grp B and A respectively. 25% pts in Grp C has excellent pain relief as compared to 20% in Grp B and 10% in Grp A. No untoward effect like nausea vomiting is noted in any patient, only 3 pts in Grp A and 2 pts in Grp B required bl transfusion. Conclusion: Local infiltration of Ropivacaine provides good analgesia. Addition of tramadol or Ketorolac prolongs the analgesic effect of Ropivacaine and lowers the VAS significantly and improves patient satisfaction score. It also decreases post-operative 24hrs NSAID or opioid consumption. Keywords: Ropivacaine, Local anaesthetic infiltration, Intraarticular, Peri articular, NSAID, Opioid.

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