Ranawat Süspansiyonunun Traneksamik Asit ile Kombine Periartiküler Enjeksiyonu Total Diz Artroplastisinde Kanama ve Ameliyat Sonrası Ağrıyı Azaltabilir
Abstract
Amaç: Lokal anestezik ajanların veya traneksamik asidin periartiküler enjeksiyonlarının faydaları daha önce bir çok ortopedik çalışmada postoperatif ağrı üzerindeki etkileri açısından değerlendirilmiştir. Ancak bu amaçla kullanılabilecek lokal anestezik ve traneksamik asit kombine kullanımının etkinliğine ilişkin veriler henüz ortaya koyulmamıştır. Bu çalışmada total diz artroplastisi uygulanan hastalarda hem traneksamik asit hem de Ranawat süspansiyonunun periartiküler enjeksiyonunun postoperatif ağrı ve kanama üzerine etkilerini araştırmayı amaçladık.
Yöntem: Bu çalışmaya total diz artroplastisi uygulanan toplam 124 hasta dahil edildi. Hastalar iki gruba ayrıldı: Ranawat süspansiyonu ve Traneksamik asit kombinasyonunu içeren bir kokteylin periartiküler enjeksiyonunu alanlar ve enjeksiyon yapılmayanlar. Gruplar arasında ameliyat sonrası ağrı, ameliyat sonrası tramadol ihtiyacı ve kan kaybı karşılaştırıldı.
Bulgular: Periartiküler Ranawat süspansiyonu ve traneksamik asit kombinasyonu uygulanlarda postoperatif üçüncü günde hemoglobin ve hematokrit seviyeleri anlamlı olarak yüksekti (sırasıyla p=0,044 ve p=0,047). Ayrıca periartiküler enjeksiyon yapılmayan hastalarda drenaj kan kaybı miktarı (p<0,001) ve kan transfüzyonu ihtiyacı (p=0,009) anlamlı olarak daha yüksekti. Ayrıca, periartiküler enjeksiyon alan hastalarda, enjeksiyon yapılmayanlara kıyasla ilk 72 saat içinde analjezik gereksinimleri de önemli ölçüde daha düşüktü.
Sonuç: Total diz artroplastisi uygulanan hastalarda Ranawat süspansiyonu ve traneksamik asit kombinasyonunu içeren bir kokteylin periartiküler enjeksiyonu majör komplikasyonlarda artışa neden olmadan kan kaybı, ağrı ve ek analjezik gereksinimini azaltmada etkilidir.
Keywords
Ranawat süspansiyonu traneksamik asit postoperatif ağrı kan transfüzyonu postoperatif analjezi
References
- 1. Curtin B, Yakkanti M, Malkani A. Postoperative pain and contracture following total knee arthroplasty comparing parapatellar and subvastus approaches. The Journal of arthroplasty. 2014;29(1):33-36. doi:10.1016/j.arth.2013.03.021
- 2. Gunaratne R, Pratt DN, Banda J, Fick DP, Khan RJK, Robertson BW. Patient Dissatisfaction Following Total Knee Arthroplasty: A Systematic Review of the Literature. The Journal of arthroplasty. 2017;32(12):3854-3860. doi:10.1016/j.arth.2017.07.021
- 3. Wheeler M, Oderda GM, Ashburn MA, Lipman AG. Adverse events associated with postoperative opioid analgesia: a systematic review. The journal of pain. 2002;3(3):159-180. doi:10.1054/jpai.2002.123652
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- 5. Collis PN, Hunter AM, Vaughn MDD, Carreon LY, Huang J, Malkani AL. Periarticular Injection After Total Knee Arthroplasty Using Liposomal Bupivacaine vs a Modified Ranawat Suspension: A Prospective, Randomized Study. The Journal of arthroplasty. 2016;31(3):633-636. doi:10.1016/j.arth.2015.09.025
- 6. Yozawa S, Ogawa H, Matsumoto K, Akiyama H. Periarticular Injection of Tranexamic Acid Reduces Blood Loss and the Necessity for Allogeneic Transfusion After Total Knee Arthroplasty Using Autologous Transfusion: A Retrospective Observational Study. The Journal of arthroplasty. 2018;33(1):86-89. doi:10.1016/j.arth.2017.08.018
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- 9. Sporer SM, Rogers T. Postoperative Pain Management After Primary Total Knee Arthroplasty: The Value of Liposomal Bupivacaine. The Journal of arthroplasty. 2016;31(11):2603-2607. doi:10.1016/j.arth.2016.05.012
- 10. Motififard M, Omidian A, Badiei S. Pre-emptive injection of peri-articular-multimodal drug for post-operative pain management in total knee arthroplasty: a double-blind randomized clinical trial. International orthopaedics. 2017;41(5):939-947. doi:10.1007/s00264-016-3357-2
- 11. Bagsby DT, Ireland PH, Meneghini RM. Liposomal bupivacaine versus traditional periarticular injection for pain control after total knee arthroplasty. The Journal of arthroplasty. 2014;29(8):1687-1690. doi:10.1016/j.arth.2014.03.034
- 12. Barrington JW, Emerson RH, Lovald ST, Lombardi A v, Berend KR. No Difference in Early Analgesia Between Liposomal Bupivacaine Injection and Intrathecal Morphine After TKA. Clinical orthopaedics and related research. 2017;475(1):94-105. doi:10.1007/s11999-016-4931-z
- 13. Bong MR, Patel V, Chang E, Issack PS, Hebert R, di Cesare PE. Risks associated with blood transfusion after total knee arthroplasty. The Journal of arthroplasty. 2004;19(3):281-287. doi:10.1016/j.arth.2003.10.013
- 14. Bierbaum BE, Callaghan JJ, Galante JO, Rubash HE, Tooms RE, Welch RB. An analysis of blood management in patients having a total hip or knee arthroplasty. The Journal of bone and joint surgery American volume. 1999;81(1):2-10. doi:10.2106/00004623-199901000-00002
- 15. Vamvakas EC, Blajchman MA. Transfusion-related mortality: the ongoing risks of allogeneic blood transfusion and the available strategies for their prevention. Blood. 2009;113(15):3406-3417. doi:10.1182/blood-2008-10-167643
- 16. Dunn CJ, Goa KL. Tranexamic acid: a review of its use in surgery and other indications. Drugs. 1999;57(6):1005-1032. doi:10.2165/00003495-199957060-00017
- 17. Good L, Peterson E, Lisander B. Tranexamic acid decreases external blood loss but not hidden blood loss in total knee replacement. British journal of anaesthesia. 2003;90(5):596-599. doi:10.1093/bja/aeg111
- 18. Wainwright TW, Gill M, McDonald DA, et al. Consensus statement for perioperative care in total hip replacement and total knee replacement surgery: Enhanced Recovery After Surgery (ERAS®) Society recommendations. Acta orthopaedica. 2020;91(1):3-19. doi:10.1080/17453674.2019.1683790
Periarticular Injection of Ranawat Suspension in Combination with Tranexamic Acid Reduces Bleeding and Postoperative Pain in Total Knee Arthroplasty
Abstract
Objective: The benefits of periarticular injections of local anesthetic agents or tranexamic acid have been previously evaluated in terms of their effects on postoperative pain in a number of orthopedic studies. However, data is lacking on the efficacy of local anesthetic and tranexamic acid combinations that may be used for this purpose. We aimed to investigate the effects of periarticular injection of both tranexamic acid and Ranawat suspension on postoperative pain and bleeding in patients undergoing total knee arthroplasty.
Methods: A total of 124 patients who underwent total knee arthroplasty were consecutively enrolled in this study. Patients were divided into two groups: those receiving the periarticular injection of a cocktail containing the combination of Ranawat suspension and Tranexamic acid and those receiving no injections. Postoperative pain, postoperative tramadol requirement and blood loss were compared between groups.
Results: Hemoglobin and hematocrit levels were significantly higher at third day postoperatively in recipients of periarticular Ranawat suspension and tranexamic acid combination (p=0.044 and p=0.047, respectively). In addition, the amount of drainage blood loss (p<0.001) and need for blood transfusions (p=0.009) were significantly higher in patients receiving no periarticular injections. Moreover, analgesic requirements were also significantly lower during the first 72 hours in recipients of periarticular injections compared to those receiving no injections.
Conclusion: Periarticular injection of a cocktail containing the combination of Ranawat suspension and tranexamic acid in patients undergoing total knee arthroplasty is effective in reducing blood loss, pain and additional analgesic requirement, without causing an increase in major complications.
Keywords
Ranawat suspension tranexamic acid postoperative pain blood transfusion postoperative analgesia
References
- 1. Curtin B, Yakkanti M, Malkani A. Postoperative pain and contracture following total knee arthroplasty comparing parapatellar and subvastus approaches. The Journal of arthroplasty. 2014;29(1):33-36. doi:10.1016/j.arth.2013.03.021
- 2. Gunaratne R, Pratt DN, Banda J, Fick DP, Khan RJK, Robertson BW. Patient Dissatisfaction Following Total Knee Arthroplasty: A Systematic Review of the Literature. The Journal of arthroplasty. 2017;32(12):3854-3860. doi:10.1016/j.arth.2017.07.021
- 3. Wheeler M, Oderda GM, Ashburn MA, Lipman AG. Adverse events associated with postoperative opioid analgesia: a systematic review. The journal of pain. 2002;3(3):159-180. doi:10.1054/jpai.2002.123652
- 4. Madjdpour C, Heindl V, Spahn DR. Risks, benefits, alternatives and indications of allogenic blood transfusions. Minerva anestesiologica. 2006;72(5):283-298. http://www.ncbi.nlm.nih.gov/pubmed/16675937
- 5. Collis PN, Hunter AM, Vaughn MDD, Carreon LY, Huang J, Malkani AL. Periarticular Injection After Total Knee Arthroplasty Using Liposomal Bupivacaine vs a Modified Ranawat Suspension: A Prospective, Randomized Study. The Journal of arthroplasty. 2016;31(3):633-636. doi:10.1016/j.arth.2015.09.025
- 6. Yozawa S, Ogawa H, Matsumoto K, Akiyama H. Periarticular Injection of Tranexamic Acid Reduces Blood Loss and the Necessity for Allogeneic Transfusion After Total Knee Arthroplasty Using Autologous Transfusion: A Retrospective Observational Study. The Journal of arthroplasty. 2018;33(1):86-89. doi:10.1016/j.arth.2017.08.018
- 7. Biedert RM, Stauffer E, Friederich NF. Occurrence of free nerve endings in the soft tissue of the knee joint. A histologic investigation. The American journal of sports medicine. 1992;20(4):430-433. doi:10.1177/036354659202000411
- 8. Elmallah RK, Chughtai M, Khlopas A, et al. Pain Control in Total Knee Arthroplasty. The journal of knee surgery. 2018;31(6):504-513. doi:10.1055/s-0037-1604152
- 9. Sporer SM, Rogers T. Postoperative Pain Management After Primary Total Knee Arthroplasty: The Value of Liposomal Bupivacaine. The Journal of arthroplasty. 2016;31(11):2603-2607. doi:10.1016/j.arth.2016.05.012
- 10. Motififard M, Omidian A, Badiei S. Pre-emptive injection of peri-articular-multimodal drug for post-operative pain management in total knee arthroplasty: a double-blind randomized clinical trial. International orthopaedics. 2017;41(5):939-947. doi:10.1007/s00264-016-3357-2
- 11. Bagsby DT, Ireland PH, Meneghini RM. Liposomal bupivacaine versus traditional periarticular injection for pain control after total knee arthroplasty. The Journal of arthroplasty. 2014;29(8):1687-1690. doi:10.1016/j.arth.2014.03.034
- 12. Barrington JW, Emerson RH, Lovald ST, Lombardi A v, Berend KR. No Difference in Early Analgesia Between Liposomal Bupivacaine Injection and Intrathecal Morphine After TKA. Clinical orthopaedics and related research. 2017;475(1):94-105. doi:10.1007/s11999-016-4931-z
- 13. Bong MR, Patel V, Chang E, Issack PS, Hebert R, di Cesare PE. Risks associated with blood transfusion after total knee arthroplasty. The Journal of arthroplasty. 2004;19(3):281-287. doi:10.1016/j.arth.2003.10.013
- 14. Bierbaum BE, Callaghan JJ, Galante JO, Rubash HE, Tooms RE, Welch RB. An analysis of blood management in patients having a total hip or knee arthroplasty. The Journal of bone and joint surgery American volume. 1999;81(1):2-10. doi:10.2106/00004623-199901000-00002
- 15. Vamvakas EC, Blajchman MA. Transfusion-related mortality: the ongoing risks of allogeneic blood transfusion and the available strategies for their prevention. Blood. 2009;113(15):3406-3417. doi:10.1182/blood-2008-10-167643
- 16. Dunn CJ, Goa KL. Tranexamic acid: a review of its use in surgery and other indications. Drugs. 1999;57(6):1005-1032. doi:10.2165/00003495-199957060-00017
- 17. Good L, Peterson E, Lisander B. Tranexamic acid decreases external blood loss but not hidden blood loss in total knee replacement. British journal of anaesthesia. 2003;90(5):596-599. doi:10.1093/bja/aeg111
- 18. Wainwright TW, Gill M, McDonald DA, et al. Consensus statement for perioperative care in total hip replacement and total knee replacement surgery: Enhanced Recovery After Surgery (ERAS®) Society recommendations. Acta orthopaedica. 2020;91(1):3-19. doi:10.1080/17453674.2019.1683790
Details
| Primary Language | English |
|---|---|
| Subjects | Orthopaedics |
| Journal Section | Research Articles |
| Authors | |
| Publication Date | October 15, 2022 |
| Submission Date | July 21, 2022 |
| Acceptance Date | October 7, 2022 |
| Published in Issue | Year 2022 Volume: 5 Issue: 3 |
The articles in the Journal of "Acta Medica Nicomedia" are open access articles licensed under a Creative Commons Attribution-ShareAlike 4.0 International License at the web address https://dergipark.org.tr/tr/pub/actamednicomedia