Clinical Research in Orthopedics

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Intraarticular Bupivacaine and Epinephrine Do Not Save Blood in Primary Total Knee Arthroplasty without Drains

Objective: After knee surgeries, the intra-articular administration of a solution mixing bupivacaine and epinephrine is a common regimen. It is logic to expect the potential in blood conservation using this regimen in total knee arthroplasty (TKA); however, there is inconsistent literature. The study was to explore the hemostatic efficacy of this regimen in our primary TKAs without drains.

Methods: A retrospective, case controlled review of our primary TKAs between 2009 and 2010 was conducted. After closure of arthrotomy, a solution containing a 40 ml vial of 0.5% bupivacaine with epinephrine 1: 200000 was given prior to the deflation of tourniquet, and two groups were simply divided according to the intra-articular injection or not. Bleeding parameters of each group, including the maximum hemoglobin reduction during stay, calculated blood loss, and transfusion requirement, were used to determine the hemostatic effect of this regimen.

Results: Over a period of 12 months, 135 eligible patients comprised a control group (N=63) and a treatment group (N=72). On a comparative basis, there was no significant different hemoglobin drop or the mean calculated blood loss of both groups (650.4 vs. 648.8 ml, p=0.90; 2.5 vs. 2.4 g/dl; p=0.63). Also, similar allogenic transfusion rates were observed between groups. [13.9% vs. 12.7%, respectively]

Conclusion: Our results suggest little hemostatic benefit of this analgesic solution containing epinephrine in non-drained primary TKA except temporary pain relief. Newer and potent regimens are still required and to be explored.

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