Utilization of epinephrine-soaked gauzes to address bleeding from osteotomy sites in non-tourniquet total knee arthroplasty: a retrospective cohort study

Abstract

Background Abandoning tourniquet was commenced because of the complications of tourniquet extensively used for the control of hemorrhage in total knee arthroplasty (TKA). Bleeding management is critical to acquire a relative bloodless arthrotomy interface for maximize cement fixation in non-tourniquet TKA. The purpose of this study was to investigate hemostatic and hemodynamic effects of epinephrine-soaked gauzes in cemented TKAs. Methods A retrospective cohort study of 101 patients in two groups was performed. The first group (n = 51) underwent unilateral TKA with our procedures of epinephrine use, the second group (n = 50) had the same protocol with tourniquet and no epinephrine utilization. Surgical field visualization was assessed by grading scale for difficulty of intraoperative visualization due to blood and number of surgical field clearances. Perioperative blood loss were recorded. Hemodynamic parameters were observed in the epinephrine group. Results There was statistically significant difference (p < 0.01) on surgeon-rated difficulty in visualization in the epinephrine group between before and after use of epinephrine, and no statistically significant differences (p = 0.96) between two groups before cementing. No statistically significantly result on numbers of surgical field clearances between two groups (p = 0.25) was reached. Significant difference in hidden blood loss, was observed in two groups (p = 0.04). The hemodynamic effects of epinephrine may be under control. Conclusion The procedure of epinephrine soaked gauzes, as a prudent adjunct, may be effective to reduce blood loss and obtain bloodless bone sections in non-tourniquet TKAs, regardless of hemodynamics.

Pediatric and Adolescent Jehovah's Witnesses: Considerations for Safe and Ethical Orthopaedic Procedures

“…Other possibilities to consider are staged approaches, a dual attending surgery (with the goal of reduced duration of surgery), and use of surgical tools such as tourniquets, electrocautery, argon-beam coagulation, topical hemostatic agents, ultrasonic bone scalpels, and local vasoconstrictive agents 86,87 During peak blood loss, packing sponges soaked in adrenaline can be utilized. 88 Temporary aortic or intra-iliac balloon occlusions have also been demonstrated to decrease blood loss in sacral tumor resection, acetabulum fracture, joint, and hip arthroplasty. [89][90][91][92] However, this has associated risks of thrombus formation, balloon rupture, or hemodynamic ischemia.…”

Can trajectory nor‐epinephrine infiltration reduce blood loss during percutaneous nephrolithotomy? A double‐blinded randomized controlled trial

“…Yet, there was no consensus about the optimum dose and/or concentration of its use (concentration may range from 1:50 000 to 1:400 000). It can be infused locally, systematically or tamponade the operative bed with NE‐soaked gauzes with no significant associated AEs 9,11,22–24 …”

“…These studies concluded that there was a clinically and statistically positive effect of these agents on the reduction of blood loss related to surgery. In addition, these hemostatic agents are physiologically Justified when mindfully used 9,10,22,24,25 . Another interesting study led by Wuethrich et al.…”

“…Also, it has a procoagulant activity that increases fibrinogen release, fibrinogen receptor activation, and activation of other coagulation factors. In addition, NE promotes thrombocytopoiesis, splenic contraction with a subsequent squeeze of more platelets into the circulation, and platelets activation, aggregation, and stabilization, besides its anti‐inflammatory action 9–11 …”

“…In addition, NE promotes thrombocytopoiesis, splenic contraction with a subsequent squeeze of more platelets into the circulation, and platelets activation, aggregation, and stabilization, besides its anti-inflammatory action. [9][10][11] Although NE is frequently used to reduce peri-operative hemorrhage during different surgical procedures, yet; to our knowledge its use during PCNL has never been studied. We hypothesized that NE injection in the PCNL trajectory reduces surgical blood loss.…”