scholarly journals Total Knee Arthroplasty with and without Tourniquet: Comparative study

2020 ◽  
Author(s):  
Sherwan Hamawandi ◽  
Hazhar I. Amin ◽  
Ameer Kadhim Al-Humairi
Keyword(s):  
Blood Transfusion ◽  
Blood Loss ◽  
Knee Arthroplasty ◽  
Thigh Pain ◽  
Early Recovery ◽  
Significant Difference ◽  
Duration Of Surgery ◽  
Group A ◽  
Group B ◽  
Without Tourniquet

Abstract Background The use of tourniquet during complete knee arthroplasty (TKA) improves protection and reduces blood loss intraoperative. Turniquet use, however, may also have a negative impact after TKA on early recovery of muscle strength and lower extremity function. The purpose of this study was to demonstrate the effect of tourniquet use in TKA on surgery length, need for blood transfusion, and amount of postoperative blood drainage by suction drain, incidence of postoperative wound hematoma, postoperative thigh pain, and early mobilization.Methods Seventy Patients are involved in this study and were divided into two groups; Group A (35) patients were treated with TKA with pneumatic thigh tourniquet. Group B (35) patients were treated with TKA without tourniquet. All patients were suffering from severe knee osteoarthritis and they failed to respond to conservative treatment so they are candidates for primary TKA. The two groups are matched related to age and gender. Selection of patients into two groups done randomly with regard of odd number for group A and even number for group B.Results The results showed no significant difference regarding age, gender, postoperative DVT and wound hematoma between group A (when tourniquet was used) and group B (when tourniquet was not used) although we have 2 patients developed DVT and 3 patients had wound hematoma in group A but these are statistically not significant. Regarding post-operative VAS for thigh pain was significantly less in group B and this will result in early mobilization. Also there was significant difference in duration of surgery between two groups with less time in group A due to bloodless field of tourniquet while there was significantly more postoperative drainage amount of blood through the surgical drains in group A and significantly more amount of blood transfusion perioperatively in group B which explain that tourniquet can reduce the total amount of blood loss in TKA.Conclusion There is significant effect of tourniquet in TKA on thigh pain postoperatively, which will effect postoperative mobilization and rehabilitation. Also the tourniquet can result in significant reduction in time of operation, total blood loss and amount of blood transfusion.

scholarly journals Total Knee Arthroplasty with and without Tourniquet: Comparative study

2020 ◽  
Author(s):  
Sherwan Hamawandi ◽  
Hazhar I. Amin ◽  
Ameer Kadhim Al-Humairi
Keyword(s):  
Blood Transfusion ◽  
Blood Loss ◽  
Knee Arthroplasty ◽  
Early Mobilization ◽  
Thigh Pain ◽  
Significant Difference ◽  
Duration Of Surgery ◽  
Group A ◽  
Group B ◽  
Without Tourniquet

Abstract Background: The use of tourniquet during complete knee arthroplasty (TKA) improves protection and reduces blood loss intraoperative. Turniquet use, however, may also have a negative impact after TKA on early recovery of muscle strength and lower extremity function. The purpose of this study was to demonstrate the effect of tourniquet use in TKA on surgery length, need for blood transfusion, and amount of postoperative blood drainage by suction drain, incidence of postoperative wound hematoma, postoperative thigh pain, and early mobilization.Methods: Seventy Patients are involved in this study and were divided into two groups; Group A (35) patients were treated with TKA with pneumatic thigh tourniquet. Group B (35) patients were treated with TKA without tourniquet. All patients were suffering from severe knee osteoarthritis and they failed to respond to conservative treatment so they are candidates for primary TKA. The two groups are matched related to age and gender. Selection of patients into two groups done randomly with regard of odd number for group A and even number for group B.Results: The results showed no significant difference regarding age, gender ,postoperative DVT and wound hematoma between group A (when tourniquet was used) and group B (when tourniquet was not used) although we have 2 patients developed DVT and 3 patients had wound hematoma in group A but these are statistically not significant. Regarding post-operative VAS for thigh pain was significantly less in group B and this will result in early mobilization. Also there was significant difference in duration of surgery between two groups with less time in group A due to bloodless field of tourniquet while there was significantly more postoperative drainage amount of blood through the surgical drains in group A and significantly more amount of blood transfusion perioperatively in group B which explain that tourniquet can reduce the total amount of blood loss in TKA.Conclusion: There is significant effect of tourniquet in TKA on thigh pain postoperatively, which will effect postoperative mobilization and rehabilitation. Also the tourniquet can result in significant reduction in time of operation, total blood loss and amount of blood transfusion.Trial registration: NCT, NCT04130009. Registered 17 October 2019 - Retrospectively registered, https://clinicaltrials.gov/NCT04130009

scholarly journals Microsurgical unilateral laminotomy for bilateral decompression of degenerative lumbar canal stenosis: a comparative study

2019 ◽  
Vol 55 (1) ◽  
Author(s):  
Mohamed I. Refaat ◽  
Amr K. Elsamman ◽  
Adham Rabea ◽  
Mohamed I. A. Hewaidy
Keyword(s):  
Patient Satisfaction ◽  
Blood Loss ◽  
Minimally Invasive ◽  
Invasive Technique ◽  
Decompression Surgery ◽  
Microsurgical Decompression ◽  
Significant Difference ◽  
Duration Of Surgery ◽  
Group A ◽  
Group B

Abstract Background The quest for better patient outcomes is driving to the development of minimally invasive spine surgical techniques. There are several evidences on the use of microsurgical decompression surgery for degenerative lumbar spine stenosis; however, few of these studies compared their outcomes with the traditional laminectomy technique. Objectives The aim of our study was to compare outcomes following microsurgical decompression via unilateral laminotomy for bilateral decompression (ULBD) of the spinal canal to the standard open laminectomy for cases with lumbar spinal stenosis. Subjects and methods Cases were divided in two groups. Group (A) cases were operated by conventional full laminectomy; Group (B) cases were operated by (ULBD) technique. Results from both groups were compared regarding duration of surgery, blood loss, perioperative complication, and postoperative outcome and patient satisfaction. Results There was no statistically significant difference between both groups regarding the improvement of visual pain analogue, while improvement of neurogenic claudication outcome score was significant in group (B) than group (A). Seventy-three percent of group (A) cases and 80% of group (B) stated that surgery met their expectations and were satisfied from the outcome. Conclusion Comparing ULBD with traditional laminectomy showed the efficacy of the minimally invasive technique in obtaining good surgical outcome and patient satisfaction. There was no statistically significant difference between both groups regarding the occurrence of complications The ULBD technique was found to respect the posterior spinal integrity and musculature, accompanied with less blood loss, shorter hospital stays, and shorter recovery periods than the open laminectomy technique.

scholarly journals Intravenous and subsequent long-term oral tranexamic acid in enhanced-recovery primary total knee arthroplasty without the application of a tourniquet: a randomized placebo-controlled trial

2019 ◽  
Vol 20 (1) ◽  
Author(s):  
Hao-Yang Wang ◽  
Liu Wang ◽  
Ze-Yu Luo ◽  
Duan Wang ◽  
Xin Tang ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Blood Loss ◽  
Tranexamic Acid ◽  
Knee Arthroplasty ◽  
Total Blood ◽  
Significant Difference ◽  
Group A ◽  
Total Knee ◽  
Group B

Abstract Background To assess the efficacy and safety of intravenous and subsequent long-term oral tranexamic acid (TXA) following total knee arthroplasty (TKA) without a tourniquet. Methods In this double-blinded trial, 118 patients undergoing primary TKA were randomized into two groups: the patients in group A received intravenous TXA at 20-mg/kg 10 min before the surgery and 3 h postoperatively, and then oral 1 g TXA from postoperative day (POD) 1 to POD 14, and the patients in group B received intravenous TXA at 20-mg/kg 10 min before surgery and 3 h postoperatively, and then oral 1 g placebo from postoperative day (POD) 1 to POD 14. The primary outcome was total blood loss. Secondary outcomes included ecchymosis area and morbidity, postoperative transfusion, postoperative laboratory values, postoperative knee function and length of hospital stay. Complications, and patient satisfaction were also recorded. Results The mean total blood loss was lower in Group A than in Group B (671.7 ml vs 915.8 ml, P = 0.001). There was no significant difference in the transfusion rate between the two groups. Group A had a higher hemoglobin than Group B on POD 3 (106.0 g/L vs 99.7 g/L, P = 0.001). However, no significant difference was found for Hb or hematocrit on POD 1 or POD 14 between the two groups. Patients in Group A had less ecchymosis morbidity (7 vs 38, P = 0.001), smaller ecchymosis area (1.6 vs 3.0, P = 0.001) than Group B. The blood coagulation level as measured by fibrinolysis (D-Dimer) was lower in Group A than in Group B on POD 1 and POD 3 (4.6 mg/L vs. 8.4 mg/L, respectively, P = 0.001; 1.5 mg/L vs. 3.3 mg/L, respectively, P = 0.001). However, there was no significant difference on POD 14, and the fibrin degradation products showed the same trend. Patients in Group A had less swelling than those in Group B on POD 3 and POD 14. The circumference of the knee was 43.1 cm vs. 46.1 cm (POD 3, P = 0.001) and 41.4 cm vs. 44.9 cm (POD 14, P = 0.001) in Group A vs Group B, respectively. Nevertheless, the circumference of the knee in the two groups was similar on POD 1 and POD 3 M. No significant differences were identified in knee function, pain score, or hospital stay. No significant differences were identified in thromboembolic complications, infection, hematoma, wound healing and patients satisfaction between the two groups. Conclusion Intravenous and subsequent long-term oral TXA produced less blood loss and less swelling and ecchymosis compared with short-term TXA without increasing the risk of complications. Trial registration The trial was registered in the Chinese Clinical Trial Registry (ChiCTR-IPR-17012264).

scholarly journals Intravenous oxytocin bolus and infusion versus infusion alone on the blood loss during caesarean section

2019 ◽  
Vol 8 (12) ◽  
pp. 4824
Author(s):  
Priyanka Mathe ◽  
Suniti Kale ◽  
Aruna Batra ◽  
Achla Batra ◽  
Shipra Aggrawal ◽  
...  
Keyword(s):  
Blood Transfusion ◽  
Blood Loss ◽  
Maternal Mortality ◽  
Subjective Assessment ◽  
Saline Group ◽  
Uterine Contractility ◽  
Period Increase ◽  
Significant Difference ◽  
Group A ◽  
Group B

Background: PPH is one of the leading causes of maternal mortality in the world. In India >30% maternal mortality is because of PPH.Methods: 250 females posted for LSCS were randomised into 2 groups. Group A: 5U oxytocin bolus + 40U oxytocin infusion @125 ml/hour in 500 ml saline. Group B: 5 ml Saline bolus + 40 U oxytocin infusionPrimary outcome was to measure blood loss (objective and subjective). Secondary outcomes were time for uterine hardening, additional uterotonic agents, hemodynamic changes, side effects and need for blood transfusion within 24 hours of LSCS.Results: Blood loss was significantly less in Group A in objective as well as subjective assessment (p<0.001). Requirement for additional oxytocin bolus was significantly higher in Group B as compared Group A (p=0.025). Postoperative hematocrit of Group A was higher than that of Group B (p<0.001). Transfusion requirement was significantly higher (p=0.04) in Group B (9.6% versus 3.2%). There was no significant difference in hemodynamics between the groups in the intraoperative period (p>0.05). However, during the postoperative period increase in heart rate was noted in Group B (p<0.05). Vomiting was the only major side effect observed, which was higher in Group A (5.6% versus 3.2%).Conclusions: Combination of 5U oxytocin bolus followed by an infusion of 40 U oxytocin given over 4 hours routinely in ASA grade I and ASA grade II parturient significantly decreases the operative blood loss during LSCS without causing any hemodynamic variability. This regimen provides better uterine contractility, lesser need for additional utero-tonic agents and lesser requirement of blood transfusion.

scholarly journals Prospective randomized trial comparing efficacy and safety of intravenous and intra-articular tranexamic acid in total knee arthroplasty

2020 ◽  
Vol 32 (1) ◽  
Author(s):  
Moses Man-Lung Li ◽  
Jojo Yan-Yan Kwok ◽  
Kwong-Yin Chung ◽  
Kin-Wing Cheung ◽  
Kwok-Hing Chiu ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Body Weight ◽  
Blood Transfusion ◽  
Blood Loss ◽  
Efficacy And Safety ◽  
Significant Difference ◽  
Group A ◽  
Total Knee ◽  
Group B ◽  
Adjusted Dose

Abstract Background Total knee arthroplasty (TKA) is associated with significant perioperative blood loss and postoperative allogenic blood transfusion. Tranexamic acid (TXA) reversibly blocks lysine binding sites on plasminogen molecules and inhibits plasmin formation. Comparisons of the efficacy and safety of intra-articular and intravenous TXA in primary TKA have not previously been reported. Methods A prospective randomized trial was conducted in 150 patients who underwent TKA, and these patients were randomized into three groups. Patients in Group A were injected by intra-articular TXA according to body weight (20 mg/kg). Patients in Group B received a standard dose of intra-articular TXA (2000 mg), and those in Group C were infused with TXA according to body weight (20 mg/kg) before tourniquet deflation and again 3 h later. Baseline characteristics and data collected at blood transfusion were compared. Differences among four time points (baseline, day 0, day 2, and day 5) were carried out using ANOVA. Results The hemoglobin levels at postoperative day 5 were 10.6 g/dL for Group A, 10.6 g/dL for Group B, and 10.7 g/dL for Group C. The drain output was 399 ml for Group A, 314 ml for Group B, and 305 ml for Group C (p = 0.03). Group C had significantly less drain output than Group A after post hoc comparisons (p = 0.05), whereas no significant difference was observed between Group A and B (p = 0.09) or between Group B and C. Conclusion The weight-adjusted dose of TXA administered intravenously significantly reduced the drain output but not the total blood loss when compared with the weight-adjusted dose of TXA administered intra-articularly. No significant difference was observed in the other parameters among the three groups. Trial registration The Joint CUHK-NTEC CREC, CRE-2013.644-T. Registered 1 March 2014.

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

2021 ◽  
Vol 15 (5) ◽  
pp. 1142-1143
Author(s):  
S. Aziz ◽  
S. Ahmed ◽  
S. A. Mahar ◽  
S. Ali ◽  
J. Kumar
Keyword(s):  
Total Knee Arthroplasty ◽  
Blood Loss ◽  
Knee Arthroplasty ◽  
Postoperative Blood Loss ◽  
Keywords Total Knee Arthroplasty ◽  
Significant Difference ◽  
Tourniquet Release ◽  
Group A ◽  
Total Knee ◽  
Group B

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

scholarly journals Comparison between scalpel incision and electrocautery incision in midline abdominal surgery: a comparative study

2021 ◽  
Vol 8 (5) ◽  
pp. 1507
Author(s):  
Amit Yadav ◽  
Lakshman Agarwal ◽  
Sumit A. Jain ◽  
Sanjay Kumawat ◽  
Sandeep Sharma
Keyword(s):  
Postoperative Pain ◽  
Blood Loss ◽  
Abdominal Surgery ◽  
Wound Infection ◽  
Skin Incision ◽  
P Value ◽  
Wound Area ◽  
Significant Difference ◽  
Group A ◽  
Group B

Background: Fear of poor wound healing have curtailed the use of diathermy for making skin incision. Scalpel produces little damage to surrounding tissue but causing more blood loss. Our aim of study was to compare electrocautery incision with scalpel incision in terms of incision time, blood loss, postoperative pain and wound infection.Methods: Total of 104 patients were included in the study undergoing midline abdominal surgery. Patients were randomized into electrocautery (group A) and scalpel (group B). The incision dimension, incision time and blood loss were noted intraoperatively. Postoperative pain was noted on postoperative day 2 using visual analog scale. Wound complications were recorded on every postoperative day till the patient was discharged.Results: 52 patients in each of the two groups were analyzed. There was significant difference found between group A and group B in terms of mean incision time per unit wound area, 8.16±1.59 s\cm2 and 11.02±1.72 s\cm2 respectively (p value=0.0001). The mean blood loss per unit wound area was found to be significantly lower in group A (0.31±0.04 ml\cm2) as compared to group B (1.21±0.21), p value=0.0001. There was no significant difference noted in terms of postoperative pain and wound infection between both groups.Conclusions: Electrocautery can be considered safe in making skin incision in midline laparotomy compared to scalpel incision with comparable postoperative pain and wound infection with less intraoperative blood loss and less time consuming.

scholarly journals Impact of the Surgical Approach: A Comparative Study between Transcanal and Posterior Tympanotomy Approach for Cochlear Implantation

2020 ◽  
Vol 3 (01) ◽  
pp. 10-15
Author(s):  
Neeraj Suri ◽  
Satya Sandilya ◽  
Ruta Sayani ◽  
Amit Anand
Keyword(s):  
Speech Intelligibility ◽  
Rating Scales ◽  
Advantages And Disadvantages ◽  
Significant Difference ◽  
Duration Of Surgery ◽  
Group A ◽  
Posterior Tympanotomy ◽  
Auditory Integration ◽  
Group B ◽  
Approach Group

Abstract Introduction The aim of our study is to compare the surgical complications of the transcanal and posterior tympanotomy approach and to evaluate the advantages and disadvantages of both techniques. Materials and Methods It is a prospective study involving 252 pediatric cochlear implant patients operated in the Department of ENT, GMERS Medical College and General Hospital, Gandhinagar, Gujarat, India. Out of these, 126 patients were operated by transcanal approach (group A) and 126 patients were operated by posterior tympanotomy approach (group B). Results No significant difference in the mean duration of surgery (p > 0.064) was observed in both the groups. Major complications occurred in 60.2% of group A and 3.1% of group B and minor complications occurred in 65% of group A and 3.1% in group B, which is highly significant (p < 0.0134). The categories of auditory perception, speech intelligibility rating scales, meaningful auditory integration scale, and meaningful use of speech scale were assessed in both groups. Conclusion Complication rate in the transcanal approach is higher as compared with posterior tympanotomy approach. A complete alignment and introduction of electrode array into the basal turn of cochlea is more favorable in the posterior tympanotomy approach. Transcanal technique even as an alternative may not be useful. Outcomes may be affected depending upon the technique chosen.

Bipolar Sealers Do not Improve Blood Loss or Functional Outcomes of Primary Total Knee Arthroplasty

2018 ◽  
Vol 33 (01) ◽  
pp. 062-066
Author(s):  
Stefano Pasqualotto ◽  
Guillaume Demey ◽  
Aude Michelet ◽  
Luca Nover ◽  
Mo Saffarini ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Blood Loss ◽  
Knee Arthroplasty ◽  
Control Group ◽  
Transfusion Rate ◽  
Significant Difference ◽  
Functional Scores ◽  
Bipolar Sealer ◽  
Total Knee ◽  
Without Tourniquet

AbstractSeveral methods were introduced to limit perioperative blood loss in total knee arthroplasty (TKA). By transcollation of soft tissues below 100°C, bipolar sealers intend to reduce bleeding and tissue damage, compared with conventional electrocautery. Existing studies report contradictory findings about the performance of bipolar sealers. The purpose of this study was to evaluate the effect of a bipolar sealer on blood loss, transfusions, hospital length of stay (LOS), and functional scores in primary TKA. In this single-center prospective study, 101 patients, undergoing primary TKA in a fast-track setting without tourniquet use, were randomly assigned to either (1) the study group which was operated with a bipolar sealer or (2) the control group operated with conventional electrocautery. The study cohort comprised 49 men and 52 women, aged 71.1 ± 8.8 years. There was no significant difference between the bipolar sealer group and the control group in terms of blood loss at day 3 (1,240 ± 547.4 vs. 1,376 ± 584.4 mL; p = ns [not significant]), transfusion rate (10 vs. 4%; p = ns), surgery time (48.2 ± 10.8 vs. 46.6 ± 9.1 minute; p = ns) or LOS (4.1 ± 2.7 vs 4.3 ± 2.0 days; p = ns). At a mean follow-up of 63.3 ± 4.9 days, there was no significant difference between the bipolar sealer group and the control group in terms of net improvement of Knee Society Score (KSS) knee (26.0 ± 16.7 vs. 23.7 ± 12.3; p = ns) and KSS function (20.4 ± 19.3 vs. 20.8 ± 19.9; p = ns). Compared with the use of conventional electrocautery in primary TKA without tourniquet, we found no effect of bipolar sealer use on blood loss, transfusion rates, LOS, or functional recovery. This is a Level II, prospective cohort study.

scholarly journals Total Laparoscopic Hysterectomy with Prior Uterine Artery Ligation at Its Origin

2014 ◽  
Vol 2014 ◽  
pp. 1-4 ◽  
Author(s):  
Vidyashree Ganesh Poojari ◽  
Vidya Vishwanath Bhat ◽  
Ravishankar Bhat
Keyword(s):  
Blood Loss ◽  
Uterine Artery ◽  
Laparoscopic Hysterectomy ◽  
Total Laparoscopic Hysterectomy ◽  
Artery Ligation ◽  
Uterine Arteries ◽  
Uterine Artery Ligation ◽  
Duration Of Surgery ◽  
Group A ◽  
Group B

We compared the duration of surgery, blood loss, and complications between patients in whom both uterine arteries were ligated at the beginning of total laparoscopic hysterectomy (TLH) and patients in whom ligation was done after cornual pedicle. Using a prospective study in a gynecologic laparoscopic center, a total of 52 women who underwent TLH from June 2013 to January 2014 were assigned into two groups. In group A, uterine arteries were ligated after the cornual pedicles as done conventionally. In group B, TLH was done by ligating both uterine arteries at the beginning of the procedure. All the other pedicles were desiccated using harmonic scalpel or bipolar diathermy. Uterus with cervix was removed vaginally or by morcellation. The indication for TLH was predominantly dysfunctional uterine bleeding and myomas in both groups. In group A, the average duration of surgery was 71 minutes, when compared to 60 minutes in group B(P<0.001). In group A, the total blood loss was 70 mL, when compared to 43#x2009;mL in group B (Pvalue < 0.001). There were no major complications in both groups. To conclude, prior uterine artery ligation at its origin during TLH reduces the blood loss and surgical duration as well as the complications during surgery.

Sign in / Sign up

Export Citation Format

Share Document