Comparison the Postoperative Blood Loss in Total Knee Arthroplasty with and without Perioperative Tourniquet Release

Objective: To compare the postoperative blood loss in total knee arthroplasty with and without perioperative tourniquet release. Study Design: Randomized control trial Place & Duration of Study: Department of Orthopaedic, M. Islam Teaching Hospital Gujranwala 1st January 2020 to 31st December 2020. Methodology: Ninety patients of both genders undergoing total knee arthroplasty were included in this study. Patient’s demographics were recorded after written consent. Patients were equally divided into two groups. Group A (45 patients) received total knee arthroplasty with tourniquet while group B (45 patients) received total knee arthroplasty without tourniquet. Postoperative blood loss was measured by suction drain, levels of haemoglobin were examined and compare between two groups. Results: The mean age of the patients in group A was 57.76±2.4 years while in group B it was 58.16±7.8 years. 32 (71.11%) and 34 (75.56%) were males while 13 (28.89%) and 11 (24.44%) were females in group A and B. We observed patients at the three different points and found lower blood loss in patients who received total knee arthroplasty with tourniquet as compared to no tourniquet group (p-value <0.05). No significant difference was observed regarding hemoglobin at 2 hours and significant differences were observed at 24 and 48 hour postoperatively. Conclusion: Tourniquet is useful to decrease loss of blood in patients undergoing total knee arthroplasty. Keywords: Total knee arthroplasty (TKA), Tourniquet, Blood loss

Impact of Dexmedetomidine on Tourniquet-Induced Systemic Effects in Total Knee Arthroplasty under Spinal Anesthesia: a Prospective Randomized, Double-Blinded Study

Background. Clinical studies on the impact of dexmedetomidine on tourniquet-induced systemic effects have been inconsistent. We investigated the impact of dexmedetomidine on tourniquet-induced systemic effects in total knee arthroplasty. Methods. Eighty patients were randomly assigned to either control (CON) or dexmedetomidine (DEX) group. The DEX group received an intravenous loading dose of 0.5 μg/kg DEX over 10 minutes, followed by a continuous infusion of 0.5 μg/kg/h from 10 minutes before the start of surgery until completion. The CON group received the same calculated volume of normal saline. Pain outcomes and metabolic and coagulative changes after tourniquet application and after tourniquet release were investigated. Results. The frequency of fentanyl administration postoperatively, patient-controlled analgesia (PCA) volume at 24 hours postoperatively, total PCA volume consumed in 48 hours postoperatively, and VAS score for pain at 24 and 48 hours postoperatively were significantly lower in the DEX group than in the CON group. Ten minutes after the tourniquet release, the DEX group showed significantly higher pH and lower lactate level than those in the CON group. Antithrombin III activity and body temperature 10 minutes after tourniquet release were significantly lower in the DEX group than in the CON group. Ca2+, K+, HCO3-, base excess, and PCO2 levels 10 minutes after tourniquet release were not significantly different between the two groups. Conclusion. We showed that DEX attenuated pain and hemodynamic, metabolic, and coagulative effects induced by the tourniquet. However, these metabolic and coagulative changes were within normal limits. Therefore, DEX could be used as an analgesic adjuvant, but should not be considered for routine use to prevent the systemic effects induced by tourniquet use.

The impact of dexmedetomidine on tourniquet induced systemic effects in total knee arthroplasty under spinal anesthesia: a prospective randomized, double-blinded study.

Background: Clinical studies on the impact of dexmedetomidine on tourniquet-induced systemic effects have been inconsistent. We investigated the impact of dexmedetomidine on tourniquet-induced systemic effects including pain outcomes in patients undergoing total knee arthroplasty under spinal anesthesia. Methods: Eighty patients were randomly assigned to either control (CON) or dexmedetomidine (DEX) group. DEX group received an intravenous loading dose of 0.5 µg/ kg DEX over 10 minutes, followed by a continuous infusion of 0.5 µg/ kg/h from 10 minutes before the start of surgery until completion. The CON group received the same calculated volume of normal saline. Pain outcomes and metabolic and coagulative changes after tourniquet application and after tourniquet release were investigated.Results: The frequency of fentanyl administration postoperatively, patient-controlled analgesia (PCA) volume at 24 hours postoperatively, total PCA volume consumed in 48 hours postoperatively, and VAS score for pain at 24 and 48 hours postoperatively were significantly lower in the DEX group than in the CON group.Ten minutes after tourniquet release, the DEX group showed significantly higher pH and lower lactate level than those in the CON group. Antithrombin III activity and body temperature 10 minutes after tourniquet release were significantly lower in the DEX group than in the CON group. Ca2+, K+, HCO3-, base excess, and PCO2 levels 10 minutes after tourniquet release were not significantly different between the two groups.Conclusion: We showed that DEX attenuated pain and hemodynamic, metabolic, and coagulative effects induced by tourniquet. However, these metabolic and coagulative changes were within normal limits. Therefore, DEX could be used as an analgesic adjuvant, but should not be considered for routine use to prevent the systemic effects induced by tourniquet use.

PENGARUH WAKTU PELEPASAN TOURNIQUET TERHADAP KADAR KALIUM PADA PENGAMBILAN DARAH VENA

ABSTRACTTourniquet can be a problem if it is tied too long and too tightly when taking venous blood can affect potassium levels and result in high false potassium levels (pseudohiperkalemia). This study aims to determine the effect of Tourniquet release time on potassium levels in venous blood collection. This study uses the Quasy Experiment method using a Non-Equivalent Control group design involving two groups with two different treatments. The variables of this study were the time of tourniquet release and potassium levels. Data processing in this study was conducted in univariate and bivariate. Analysis of the data in this study also used the Independent T Test to determine the effect between variables.The results of the study through statistical analysis showed that the average blood potassium level in the first group was 3.784 mEq / L and the second group was 4.896 mEq / L. From the results of statistical tests obtained a value of P value (0,000) <α (0.05) which means Ha is accepted so that the results of this study are there are differences in the average potassium levels at the moment of release of tourniquet blood entering and releasing the tourniquet after blood. The conclusion of this study is that the release time of the tourniquet can affect potassium levels and it is recommended for medical personnel to release the tourniquet while the blood enters the syringe needle when taking venous blood to avoid high levels of potassium in the serum.Keywords: Tourniquet Release, Potassium Levels, and Pseudohiperkalemia