Purpose It is not clear whether type of surgical approach affects the amount of blood loss in one-stage bilateral total hip arthroplasty (THA). This study therefore aims to examine if type of surgical approach can affect peri-operative blood loss and allogeneic blood transfusion in patients undergoing one-stage bilateral THA. Methods Records of 319 patients who underwent one-stage bilateral THA from January 2004 to June 2011 were retrospectively reviewed. Patients were divided into two groups: direct anterior (DA) approach (75 patients) and direct lateral (DL) approach (244 patients). Blood loss was calculated using a previously validated formula. Blood loss and need for allogeneic blood transfusion were compared between the two groups. Additionally, the effects of using cell saver and surgical approach were evaluated in a multivariate analysis. Results Compared to the DL approach, calculated blood loss was significantly lower in the DA group (2,813.90±804.13 ml vs 3,617.03±1,148.47 ml) and a significantly lower per cent of patients needed allogeneic blood transfusion in the DA group (26.6 vs 52.4 %). Intra-operative cell saver was used in 36 patients. Compared to the non-cell saver group, mean blood loss was significantly higher in the cell saver group (4,061.0± 1,285.55 ml vs 3,347.71±1,083.85 ml), whereas the difference between the two groups regarding allogeneic blood transfusion was not statistically significant. The DA approach was an independent predictor of lower peri-operative blood loss and allogeneic blood transfusion while using cell saver was not.Conclusions Our results may be explained by the lower extent of muscular dissection performed in the DA approach. Our findings also indicate that intra-operative cell salvage might not be justified in bilateral THA performed expeditiously.
BACKGROUND:Transversus abdominis plane blocks improve postoperative pain after colon and rectal resections, but the benefits of liposomal bupivacaine use for these blocks have not been clearly demonstrated. OBJECTIVE:This study aimed to determine whether using liposomal bupivacaine in transversus abdominis plane blocks improves postoperative pain and reduces opioid use after colorectal surgery compared to standard bupivacaine. DESIGN:This study was a single-blinded, singleinstitution, prospective randomized controlled trial comparing liposomal bupivacaine to standard bupivacaine in transversus abdominis plane blocks in patients undergoing elective colon and rectal resections. SETTINGS:This study was conducted at a singleinstitution academic medical center with 6 staff colorectal surgeons and 2 colorectal surgery fellows.PATIENTS: Ninety-six patients aged 18 to 85 years were assessed for eligibility; 76 were included and randomly assigned to 2 groups of 38 patients. INTERVENTIONS:Patients in the experimental group received liposomal bupivacaine transversus abdominis plane blocks, whereas the control group received standard bupivacaine blocks. MAIN OUTCOME MEASURES:The primary outcome was maximum pain score on postoperative day 2. Secondary outcomes included daily maximum and average pain scores in the 3 days after surgery, as well as daily morphine milligram equivalent use and length of hospital stay. RESULTS:Patients receiving liposomal bupivacaine blocks had lower maximum pain scores on the day of surgery (mean, 6.5 vs 7.7; p = 0.008). No other difference was found between groups with respect to maximum or average pain scores at any time point postoperatively, nor was there any difference in morphine milligram equivalents used or length of stay (median, 3.1 d).LIMITATIONS: This was a single-institution study with only patients blinded to group assignment.CONCLUSIONS: Liposomal bupivacaine use in transversus abdominis plane blocks for patients undergoing laparoscopic colorectal resections does not seem to improve postoperative pain, nor does it reduce narcotic use or decrease length of stay. Given its cost, use of liposomal bupivacaine in transversus abdominis plane blocks is not justified for colon and rectal resections. See Video Abstract at http://links.lww.com/DCR/B979.
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