Submit manuscript

Comparison of Intra- and Post-operative Blood Loss Between Intermittent and Conventional Early Release Tourniquet Application in Total Knee Arthroplasty: A Randomized Controlled Trial

Pongsatorn Chailertpongsa MD1, Sukit Saengnipanthkul MD1, Rit Apinyankul MD1

Affiliation : 1 Department of Orthopaedics, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand

Background : Early tourniquet release (before wound closure) in total knee arthroplasty [TKA] has been advocated to have advantages over late release (after skin closure), but the early release can significantly increase perioperative blood loss. To reduce intra-operative blood loss, a new technique called “intermittent early tourniquet release [IETR]” has been developed.
Objective : To compare intra- and post-operative blood loss between IETR and conventional early tourniquet release [CETR] techniques in primary TKA.
Materials and Methods : A prospective randomized controlled trial was conducted with 28 patients aged over 50 years who had been diagnosed with primary knee osteoarthritis and who were scheduled to undergo primary cemented TKA involving application of a pneumatic tourniquet. In all cases, after cementation of the prosthesis, the tourniquet was released. For patients randomized to the IETR group, the tourniquet was then re-inflated to the previous pressure (without re-exsanguination) one minute after the initial release. The tourniquet was again released after 2 minutes of second re-inflated. Tourniquets were not re-inflated after the initial releasein patients in the CETR group. Intra- and post-operative blood loss was measured in addition to measurement of hemoglobin and hematocrit levels 24 hours post-operatively. Estimated blood volume loss [BVL] was also calculated.
Results : Pre-operative characteristics in both groups were similar. Following the operation, there was no significant difference between the IETR and CETR groups in intra-operative blood loss (mean difference -1.0, 95% CI -51.7, 49.8), post-operative blood loss (mean difference -5.2, 95% CI -218.9, 208.5). Estimated BVL and decreases in hemoglobin and hematocrit level were not significantly smaller in the IETR group (mean difference (69.64, 95% CI -92.1, 231.3, p = 0.384), (0.3, 95% CI -0.1, 0.8, p = 0.148) and (1.5, 95% CI -0.1, 3.0, p = 0.070), respectively). In addition, there was no difference in either the number of blood transfusions or in the incidence of tourniquet-related complications.
Conclusion : The IETR technique helps reduce estimated post-operative BVL and decreases in hemoglobin and hematocrit levels compared to the CETR technique, although the differences are not statistically significant. Re-inflation of the tourniquet after initial deflation does, however, improve surgical field visualization, facilitating cauterization of bleeding blood vessels and results in no increase in tourniquet-related complications.

Keywords : Total knee arthroplasty, Early tourniquet release, Intra-operative blood loss


All Articles Download


INFORMATION

Contact info

JOURNAL OF THE MEDICAL ASSOCIATION OF THAILAND
4th Floor, Royal Golden Jubilee Building,
2 Soi Soonvijai, New Petchburi road,
Bangkok 10310, Thailand.
Phone: 0-2716-6102, 0-2716-6962
Fax: 0-2314-6305
Email: editor@jmatonline.com

JMed Assoc Thai
MEDICAL ASSOCIATION OF THAILAND
ISSN: 0125-2208 (Print),
ISSN: 2408-1981 (Online)
The content of this site is intended for health professionals.

Submissions

» Online Submissions » Author Guidelines » Copyright Notice » Privacy Statement

Other

» Journal Sponsorship » Site Map » About this Publishing System

© MEDICAL ASSOCIATION OF THAILAND. All Rights Reserved. The content of this site is intended for health professionals.