Preoperative Acute Normovolaemic Hemodilution (ANH) in combination with Hypotensive Epidural Anaesthesia (HEA) during knee arthroplasty surgery. No effect on transfusion rate. A randomized controlled trial [ISRCTN87597684]

Abstract

Background: Hypotensive epidural anaesthesia (HEA) combines a high epidural anaesthesia, performing a sympathetic blockade, with low-dose iv-infusion of epinephrine to stabilize circulation in the conscious patient. Mean artery blood pressure is reduced to 45-50 mmHg and hereby a reduced blood loss. In this study we have combined HEA with preoperative acute normovolaemic hemodilution (ANH) in attempt to further reduce the blood loss and need for blood transfusion in total knee arthroplasty surgery (TKR).

Local infusion of norepinephrine reduces blood losses and need of transfusion in total knee arthroplasty

“…Indeed, bleeding during and after TKA is often associated with cardiovascular complications and a high transfusion rate of allogenic blood [4]. Recently, drainage clamping, associated with epinephrine solution infusion, has been shown to be effective at reducing blood loss.…”

“…Since allogenic blood transfusion increases the risk of immunological and non-immunological adverse effects for the patients and increases medical costs [2,4], intraoperative use of norepinephrine should be considered as an effective method of preventing these severe complications and reducing the cost of blood management in knee replacement surgery. This is the first study in which the reduction of blood loss and allogenic blood transfusion requirements in TKA have been achieved by the simple expedient of local administration of norepinephrine.…”

“…Extensive blood loss during and after TKA is associated with a high risk of, in particular, cardiovascular complications, and a high transfusion rate of allogenic blood [4]. Furthermore, allogenic blood transfusion increases the risk of immunological and nonimmunological adverse effects for patients, including postoperative infections and disease transmission, and increases medical costs [2][3][4].…”

“…Extensive blood loss during and after TKA is associated with a high risk of, in particular, cardiovascular complications, and a high transfusion rate of allogenic blood [4]. Furthermore, allogenic blood transfusion increases the risk of immunological and nonimmunological adverse effects for patients, including postoperative infections and disease transmission, and increases medical costs [2][3][4]. For these reasons various methods to reduce blood loss, such as postoperative autotransfusion [9], the use of a femoral intramedullary plug [6] and intravenous administration of tranexamic acid [1,10] have been proposed.…”

Preoperative Acute Normovolemic Hemodilution for Minimizing Allogeneic Blood Transfusion

“…14,21,30,40,47,62,65 These studies revealed that the overall volume of perioperative blood loss was similar in the PANH group and the control group (WMD, 21.98 mL; 95% CI, −46.90 to 90.86 mL; P = 0.53). These results are presented in the forest plot in Figure 4.…”