Safety and efficacy of epsilon aminocaproic acid (EACA) as an antihemorrhagic drug in bilateral one stage total knee arthroplasty: A double-blind randomized controlled trial.

BACKGROUND: Antifibrinolytic drugs are widely used to minimize blood loss and transfusion requirements in total knee arthroplasty (TKA). Although tranexamic acid (TXA) has been widely studied for its use in TKA, there are limited studies on epsilon-aminocaproic acid (EACA). METHODS: In a double-blind randomized control trial, all patients (n = 91) operated with bilateral simultaneous TKA were randomly given either intravenous EACA or placebo (normal saline). A single surgeon performed the TKA with posterior-stabilized implants under tourniquet. A suction drain was placed and kept for 48 h postoperatively. The intraoperative blood loss and drain output were calculated. The postoperative hemoglobin (Hb), drop in Hb, total blood loss, and number of blood transfusions in each group were calculated. RESULTS: Both of the groups were comparable in terms of age, sex, body mass index, and pre-operative Hb. There was a significant difference between the EACA group and control group in terms of intraoperative blood loss (150 ml vs. 165 ml, P = 0.01), drain output (494 ml vs. 1062 ml, P < 0.001), postoperative Hb (9.9 g/dl vs. 8.6 g/dl, P = 0.002), drop in Hb (2.2 g/dl vs. 3.1 g/dl, P = 0.026) and transfusion rate (median transfusion 0 vs. 1, P < 0.001). The total blood loss, as calculated by the Hb balance method, was significantly less (P < 0.001) in the EACA group (0.99 l) compared with the control group (2.71 l). None of the patients developed any adverse reaction/complication to the drug. CONCLUSION: Intraoperative administration of EACA significantly decreased the blood loss and postoperative transfusion rates compared with no antifibrinolytic therapy in bilateral simultaneous TKA.

Single dose Intravenous Tranexamic acid may not be adequate to reduce blood loss and blood transfusion requirement in patients undergoing single stage bilateral total knee arthroplasty.

Simultaneous bilateral total knee arthroplasty (TKA) causes increased blood loss and increases the risk of venous thromboembolism. Tranexamic acid (TXA) is commonly used to minimize blood loss and transfusion requirements. However, the optimal regimen of TXA in single stage bilateral TKA is still not defined. In this retrospective study, 35 patients who received TXA and 31 patients who did not receive TXA were evaluated for blood loss and transfusion requirement. Both the groups were comparable in terms of age, sex, body mass index and preoperative haemoglobin (Hb) and haematocrit (Hct). There was no significant difference in the change in Hb levels (2.42 ± 1.28 vs 2.44 ± 1.31 ; p=0.95) and Hct (1.37 ± 0.96 vs 1.62 ± 0.98, p=0.22) between the groups. There were no significant differences between the study and control groups in the intraoperative blood loss (163.71 vs 165.32 ml, p=0.92), drain output (621.71 vs 695.65 ml, p=0.65) and total blood loss (785.0 vs 860.97, p=0.40). There was no significant difference in allogeneic blood transfusion between the groups (62.85% received blood in the study group vs 58.06% in the control group, p>0.05). Single intraoperative dose of TXA may not be adequate to reduce blood loss and blood transfusion requirement in bilateral TKA.

Kiloh-Nevin syndrome associated with humeral shaft fracture.

Fracture humerus may be associated with nerve injuries. However, among them median nerve is uncommonly involved and clinical affection of the anterior branch of median nerve is rare which can be easily missed and could be under-reported. A 42-year-old man presented with closed fracture of shaft of humerus right sided following fall. He had isolated weakness of flexor pollicis longus and flexor digitorum profundus of index finger without any other sensorimotor dysfunction. The findings were consistent with isolated palsy of anterior interosseous nerve (AIN). The patient was operated with fixation of humerus without exploring the AIN. At 6-month follow-up, the patient had complete recovery of both the muscles. This case highlights the classical clinical presentation of a rare injury associated with humerus fracture. Awareness and knowledge of this entity is of paramount importance for the practitioners.