Application of tranexamic acid combined with intra-articular cocktail and TXA mixture perfusion in pri-mary total knee arthroplasty / 实用医学杂志

ABSTRACT

Objective To investigate the efficacy and safety of intravenous tranexamic acid(TXA)admin-istration combined with intra-articular"cocktail"+TXA infusion in primary total knee arthroplasty(TKA). Meth-ods 90 patients were randomly divided to experimental group A,control group B and control group C,30 cases in each group.There was no significant difference(P>0.05) in the preoperative general informations,such as age, sex,body mass index,hemoglobin,hematocrit,D-dimer,preoperative KSS score,knee activity ROM,VAS scores,operation time,time of using tourniquet. All the patients were intravenously injected with TXA 1g before using the tourniquet. After suturing the capsule,for the group A,100 ml of TXA and cocktail mixture(TXA 1g, ropivacaine 40 mg,epinephrine 0.1 mg,methylprednisolone 40 mg) were perfused into the articular cavity through the drainage which then be clamped.By the same ways,group B patients infused with tranexamic acid solution 100 mL(TXA 1g),group C patients infused with saline 100 mL.The total blood loss volume,drainage volume,intraop-erative blood loss,hidden blood loss,the change of hemoglobin and hematocrit in postoperative 3 days,blood trans-fusion,adverse reactions,the VAS scores at 6,12,24,72 h in the postoporative quiescent condition and the VAS scores at 12,24,72 h in the postoporative activity condition were measured and compared.Results The volume of total blood loss,hidden blood loss,drainage,were(685.7 ± 120.6)mL、(259.9 ± 162.0)mL、(151.5 ± 48.9)mL in group A,the decrease of hemoglobin and hematocrit at postoperative 3 d were(18.6 ± 3.2)g/L、(3.1 ± 1.3)% in group A,there was statistically significant(P<0.05) comparing with the control groups.The VAS scores of experi-mental group in the resting and the active state were lower than that in control groups(P < 0.05). Conclusion The application of intravenous tranexamic acid administration combined with intra-articular"cocktail"+TXA infu-sion can reduce the volume of postoperative total blood loss,drainage and hidden blood loss.Simultaneously,it can significantly alleviate the early postoperative pain,which is conducive to early rapid recovery,while not increasing the risk of thrombosis,and no adverse reactions.