ABSTRACT
Objective To assess the effect and safety of intraarticular infusion combined with intravenous injection of tranexamic acid on hemorrhage in patients underwent total knee replacement (TKR).Methods A total of 180 patients who underwent TKR in the People's Hospital of Hebi City from January 2014 to January 2017 were selected.The patients were divided into control group,low dose group and high dose group according to the tranexamic acid dose,60 cases in each group.All patients were treated with tranexamic acid 10 mg · kg-1 by intravenous drip within one hour before operation.After the incisions were sutured,the patients in the control group were treated with physiological saline 100 mL by intraarticular infusion,the patients in the low dose group and high dose group received intraarticular infusion of tranexamic acid 1 and 2 g respectively,the drainage tube was opened after one hour's occlusion.The operation time,hemoglobin level,postoperative blood loss,total blood loss and complications were observed and recorded.Results There was no significant difference in hemoglobin level in the three groups before operation (P ＞ 0.05).The hemoglobin level in the high dose group was significantly higher than that in the low dose group and the control group (P ＜ 0.05),but there was no significant difference in hemoglobin level between the low dose group and the control group at one day after operation (P ＞ 0.05).The hemoglobin level in the low dose group and the high dose group was significantly higher than that in the control group (P ＜ 0.05),and it in the high dose group was significantly higher than that in the low dose group at two days after operation (P ＜ 0.05).There was no significant difference in the operation time in the three groups (P ＞ 0.05).The postoperative blood loss and total blood loss in the low dose group and the high dose group were significantly lower than those in the control group (P ＜ 0.05),and them in the high dose group were significantly lower than those in the low dose group (P ＜ 0.05).The incidence of complications in the control group,low dose group and high dose group was 8.33％ (5/60),10.00％ (6/60) and 8.33％ (5/60) respectively,there was no significant difference in the incidence of complications among the three groups (x2 =0.100,P ＞ 0.05).Conclusion Intraarticular infusion combined with intravenous injection of tranexamic acid can effectively reduce blood loss in patients with TKR.Increasing the dose of intraarticular infusion of tranexamic acid within a certain range can further improve the hemostatic effect,and it does not increase the complications.
ABSTRACT
BACKGROUND: Arthroscopic shoulder surgery can result in severe postoperative pain. A variety of methods have been used to control pain in postoperative period and the results are variable. The purpose of this study was to compare the relative analgesic efficacies of the postoperative intraarticular infusion of ropivacaine, ropivacaine/fentanyl, and ropivacaine/fentanyl/ketorolac after arthroscopic shoulder surgery. METHODS: Thirty patients undergoing arthroscopic shoulder surgery under general anesthesia were randomly assigned to three groups. At the end of surgery, 0.5% ropivacaine 20 ml was infused into the articular space and a continuous infusion catheter was inserted into intraarticular operated site. After surgery, continuous infusion of 0.5% ropivacaine 100 ml (Group 1, n = 10), 0.5% ropivacaine 100 ml including fentanyl 10 microg/kg (Group 2, n = 10), or 0.5% ropivacaine 100 ml including fentanyl 10 microgram/kg and ketorolac 150 mg (Group 3, n = 10) was started through catheter at rate of 2 ml/hr with bolus dose of 0.5 ml with a lock out time of 15 minutes for 2 days. The level of pain was assessed using a visual analogue scale (VAS) postoperative 2, 6, 12, 24 and 48 hours and the amounts of supplemental analgesics were recorded. RESULTS: The VAS was significantly lower after 2, 6, 12 hours in Group 2 than in Group 1. In Group 3, the VAS was significantly lower all hours than in the other two groups. CONCLUSIONS: The combination of fentanyl and ketorolac with ropivacaine did provide better postoperative analgesia than the other groups after arthroscopic shoulder surgery.