Epinephrine-augmented Hypotensive Epidural Anesthesia Replaces Tourniquet Use in Total Knee Replacement

Kiss, H; Raffl, M.; Neumann, Daniel; Hutter, Jörg; Dorn, U.

doi:10.1097/01.blo.0000161825.90633.12

Cited by 33 publications

(18 citation statements)

References 9 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Five literatures were not RCTs, and two trials included bilateral TKA during the same surgery [16,17]. What is more, two studies were excluded for some intervening measures with potential to influence the result [18,19]. For one, in Kiss et al's study, the non-tourniquet group used epinephrine-augmented hypotensive epidural anesthesia, and the tourniquet group patients received normotensive epidural anesthesia [18].…”

Section: Resultsmentioning

confidence: 99%

“…What is more, two studies were excluded for some intervening measures with potential to influence the result [18,19]. For one, in Kiss et al's study, the non-tourniquet group used epinephrine-augmented hypotensive epidural anesthesia, and the tourniquet group patients received normotensive epidural anesthesia [18]. Epinephrine-augmented hypotensive epidural anesthesia could affect the blood loss [20], which might influence on other aspects of patients.…”

Section: Resultsmentioning

confidence: 99%

See 1 more Smart Citation

The effects of a tourniquet used in total knee arthroplasty: a meta-analysis

et al. 2014

View full text Add to dashboard Cite

BackgroundThe purpose of this research is to evaluate the effects of a tourniquet in total knee arthroplasty (TKA).MethodsThe study was done by randomized controlled trials (RCTs) on the effects of a tourniquet in TKA. All related articles which were published up to June 2013 from Medline, Embase, and Cochrane Central Register of Controlled Trails were identified. The methodological quality of the included studies was assessed by the Physiotherapy Evidence Database (PEDro) scale. The meta-analysis was performed using Cochrane RevMan software version 5.1.ResultsThirteen RCTs that involved a total of 689 patients with 689 knees were included in the meta-analysis, which were divided into two groups. The tourniquet group included 351 knees and the non-tourniquet group included 338 knees. The meta-analysis showed that using a tourniquet in TKA could reduce intraoperative blood loss (weighted mean difference (WMD), -198.21; 95% confidence interval (CI), -279.82 to -116.60; P < 0.01) but did not decrease the calculated blood loss (P = 0.80), which indicates the actual blood loss. Although TKA with a tourniquet could save the operation time for 4.57 min compared to TKA without a tourniquet (WMD, -4.57; 95% CI, -7.59 to -1.56; P < 0.01), it had no clinical significance. Meanwhile, the use of tourniquet could not reduce the possibility of blood transfusion (P > 0.05). Postoperative knee range of motion (ROM) in tourniquet group was 10.41° less than that in the non-tourniquet group in early stage (≤10 days after surgery) (WMD, -10.41; 95% CI, -16.41 to -4.41; P < 0.01). Moreover, the use of a tourniquet increased the risk of either thrombotic events (risk ratio (RR), 5.00; 95% CI, 1.31 to 19.10; P = 0.02) or non-thrombotic complications (RR, 2.03; 95% CI, 1.12 to 3.67; P = 0.02).ConclusionsTKA without a tourniquet was superior to TKA with a tourniquet in thromboembolic events and the other related complications. There were no significant differences between the two groups in the actual blood loss. TKA with a tourniquet might hinder patients' early postoperative rehabilitation exercises.

show abstract

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

The effects of a tourniquet used in total knee arthroplasty: a meta-analysis

et al. 2014

View full text Add to dashboard Cite

show abstract

“…A few studies have proved its safety and efficacy in total hip arthroplasty (THA), but further studies are needed to assess its use in TKA[70,72,73]. …”

Section: Intra-operativementioning

confidence: 99%

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

Themistoklis¹,

Vogiatzaki²,

Kazakos³

et al. 2017

WJO

View full text Add to dashboard Cite

Total knee replacement (TKR) is one of the most common surgeries over the last decade. Patients undergoing TKR are at high risk for postoperative anemia and furthermore for allogeneic blood transfusions (ABT). Complications associated with ABT including chills, rigor, fever, dyspnea, light-headedness should be early recognized in order to lead to a better prognosis. Therefore, perioperative blood management program should be adopted with main aim to reduce the risk of blood transfusion while maximizing hemoglobin simultaneously. Many blood conservation strategies have been attempted including preoperative autologous blood donation, acute normovolemic haemodilution, autologous blood transfusion, intraoperative cell saver, drain clamping, pneumatic tourniquet application, and the use of tranexamic acid. For practical and clinical reasons we will try to classify these strategies in three main stages/pillars: Pre-operative optimization, intra-operative and post-operative protocols. The aim of this work is review the strategies currently in use and reports our experience regarding the perioperative blood management strategies in TKR.

show abstract

“…Although hypotension anesthesia is commonly used in TKA, there are few reports evaluating its effectiveness in TKA. A prospective, randomized, single-blind study of 100 patients treated with TKA showed that controlled hypotension reduced the drop in Hb levels when compared with using a tourniquet 45 . The results of the study showed that the Hb concentration in the hypotensive anesthesia group was higher at the end of surgery, and 5 and 6 days after surgery (P = 0.043, 0.012, 0.014 respectively).…”

Section: Hypotensive Anesthesiamentioning

confidence: 99%

Perioperative Blood Management Strategies for Total Knee Arthroplasty

Lü

Peng

Zhou

et al. 2018

Orthopaedic Surgery

View full text Add to dashboard Cite

Total knee arthroplasty (TKA) often causes a significant amount of blood loss with an accompanying decline in hemoglobin and may increase the frequency of allogeneic blood transfusion rates. Unfortunately, allogeneic blood transfusions have associated risks including postoperative confusion, infection, cardiac arrhythmia, fluid overload, increased length of hospital stay, and increased mortality. Other than reducing the need for blood transfusions, reducing perioperative blood loss in TKA may also minimize intra-articular hemorrhage, limb swelling, and postoperative pain, and increase the range of motion during the early postoperative period. These benefits improve rehabilitation success and increase patients' postoperative satisfaction. Preoperative anemia, coupled with intraoperative and postoperative blood loss, is a major factor associated with higher rates of blood transfusion in TKA. Thus, treatment of preoperative anemia and prevention of perioperative blood loss are the primary strategies for perioperative blood management in TKA. This review, combined with current evidence, analyzes various methods of blood conservation, including preoperative, intraoperative, and postoperative methods, in terms of their effectiveness, safety, and cost. Because many factors can be controlled to reduce blood loss and transfusion rates in TKA, a highly efficient, safe, and cost-effective blood management strategy can be constructed to eliminate the need for transfusions associated with TKA.

show abstract

Epinephrine-augmented Hypotensive Epidural Anesthesia Replaces Tourniquet Use in Total Knee Replacement

Cited by 33 publications

References 9 publications

The effects of a tourniquet used in total knee arthroplasty: a meta-analysis

The effects of a tourniquet used in total knee arthroplasty: a meta-analysis

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

Perioperative Blood Management Strategies for Total Knee Arthroplasty

Contact Info

Product

Resources

About