scholarly journals OUTCOMES OF MULTIMODAL COCKTAIL VS TRANEXAMIC ACID ON POST OPERATIVE PAIN AND BLOOD LOSS IN TOTAL KNEE REPLACEMENT PATIENTS: A PROSPECTIVE RANDOMIZED STUDY

2020 ◽  
Vol 4 (8) ◽  
Author(s):  
Suhail Malhotra ◽  
Parminder Kaur
Keyword(s):  
Postoperative Pain ◽  
Blood Loss ◽  
Total Knee Replacement ◽  
Tranexamic Acid ◽  
Pain Score ◽  
Knee Replacement ◽  
Control Group ◽  
Total Knee ◽  
The Mean ◽  
The Difference

Background: Osteoarthritis is the most common form of arthritis and a leading cause of disability. Total knee replacement (TKR) is one of the most effective surgical procedures, providing improvement in function and relief of pain for the majority of patients. Intra-articular tranexamic acid [TXA] and multimodal cocktail (mixture of ketorolac, tramadol and bupivacaine) are commonly used drugs which help to reduce postoperative bleeding and pain respectively, improving outcome of surgery. Objective: To compare the postoperative blood loss and pain with or without Intra-articular tranexamic acid and multimodal cocktail respectively in patients undergoing total knee replacement Material and Methods: A total of 96 patients of either gender presenting to Orthopaedics department of Government Medical College, Amritsar, with knee osteoarthritis and planned to undergo total knee replacement were enrolled. Patients were divided into 3 groups. Group A being the control group was not given tranexamic acid [TXA] but only standard drugs for anesthesia. Group B patients were given 3gm intra-articular injection of tranexamic acid. Group C patients were given a multimodal cocktail (mixture of ketorolac, tramadol and bupivacaine. TKR was done and patients were followed-up for 72 hours. Blood loss and pain score after every 24 hours for 72 hours were noted. Intra-articular injections were given just before wound closure. Results: The mean age of patients in control group was 48.92±13.22years, in TXA group was 52.31±14.69 years and in cocktail group was 50.22±9.63years. The male to female ratio was 11:21, 14:18 and 10:22 in three groups respectively. The total blood loss during first 72 hours was 1030.1±177.27ml in control group, 453.7±80.4ml in TXA group while 607.7±122.5ml in cocktail group. The difference was significant in all three groups and also between TXA and cocktail group (p<0.05). The mean postoperative pain score during first 72 hours was 4.4±2.3in control group, 2.4±1.5 in TXA group while 1.8±1.0in cocktail group. The difference was significant in all three groups (p<0.05) but insignificant between TXA and cocktail group (p>0.05). Conclusion: Results showed that intra-articular injection of TXA is beneficial in reducing blood loss and postoperative pain in comparison to control group. While pain was better controlled with the multimodal cocktail compared to TXA group and control group. Keywords: Post-operative blood loss, Intra-articular injection, tranexamic acid, cocktail, total knee replacement

scholarly journals Local infiltration of analgesia and tranexamic acid is safe and efficacious in reducing blood loss and comparable to intra-articular tranexamic acid in total knee replacements

2021 ◽  
Author(s):  
H Sivasubramanian ◽  
CMP Tan ◽  
L Wang
Keyword(s):  
Pain Relief ◽  
Blood Loss ◽  
Total Knee Replacement ◽  
Tranexamic Acid ◽  
Knee Replacement ◽  
Functional Outcomes ◽  
Primary Total Knee Replacement ◽  
Total Knee ◽  
The Mean ◽  
Primary Total Knee

Introduction: The use of peri-articular (PA) tranexamic acid (TXA) and its efficacy in comparison with intra-articular (IA) tranexamic acid has not been well explored in literature. This retrospective cohort study aims to compare the effects of IA and PA TXA with analgesic components in reducing blood loss and improving immediate post-operative pain relief and functional outcomes in unilateral primary total knee replacement (TKA) patients. Methods: 63 patients who underwent a unilateral primary total knee replacement procedure were divided into 2 groups: 42 patients in the IA TXA delivery group, 21 patients in the PA TXA group. 1g of TXA was utilized for all patients. All patients had pericapsular infiltration consisting of 0.5ml of Adrenaline, 0.4ml of Morphine, 1g of Vancomycin, 1ml of Ketorolac and 15ml of Ropivacaine. Outcomes for blood loss, and surrogate markers for immediate functional recovery were measured. Results: 54.0% of the patients were female, 46.0% male. The mean drop in post-operative Hb levels in the PA and IA group was 2.0g/dL and 1.6 g/dL respectively, and statistically insignificant (p=0.10). The mean HCT drop in the PA and IA group was 6.1% and 5.3% respectively and statistically insignificant (p=0.58). The POD 1 and discharge day flexion angles, POD 1 and POD 2 VAS scores, gait distance on discharge, and length of hospitalization stay were largely similar in both groups. Conclusion: Our study shows that both IA and PA TXA with analgesic components are equally efficient in reducing blood loss and improving immediate postoperative pain relief and functional outcomes.

scholarly journals Intraarticular vs Intravenous Tranexamic Acid in Reduction of Blood Loss in Primary Total Knee Replacement

2016 ◽  
Vol 50 (2) ◽  
pp. 64-68
Author(s):  
Arunkumar Vijay ◽  
Jambu Nageswaran ◽  
Senthil Loganathan ◽  
Samuel Chittaranjan Bedford
Keyword(s):  
Blood Loss ◽  
Total Knee Replacement ◽  
Tranexamic Acid ◽  
Knee Replacement ◽  
Primary Total Knee Replacement ◽  
Group A ◽  
Total Knee ◽  
The Mean ◽  
Group B ◽  
Primary Total Knee

ABSTRACT Aim To study the efficacy of topical intraarticular vs intravenous tranexamic acid (TXA) in reducing blood loss following primary total knee replacement (TKR). Materials and methods A phase 3, single center, double blind and randomized controlled study was conducted in the Department of Orthopedics, Sri Ramachandra University, Chennai, Tamil Nadu. A prospective study of 100 patients lasted from July 2013 to July 2015. Results Postoperative transfusion rates were zero in both the groups (intraarticular and intravenous). The mean 48-hour drain collected is 285.6 ml in group A (intraarticular), while it is 325.8 ml in group B (intravenous); the mean drop in hemoglobin is 1.7 gm/dl in group A (intraarticular) while it is 2.4 gm/dl in group B (intravenous). Conclusion This study shows that topical intraarticular administration of TXA has better efficacy than intravenous TXA in controlling postoperative blood loss following primary uncomplicated TKR with no significant complications. How to cite this article Vijay A, Nageswaran J, Loganathan S, Bedford SC. Intraarticular vs Intravenous Tranexamic Acid in Reduction of Blood Loss in Primary Total Knee Replacement. J Postgrad Med Edu Res 2016;50(2):64-68.

scholarly journals Comparison of Blood Loss using Intra-Articular Injection of Tranexamic Acid after Total Knee Replacement

2020 ◽  
Vol 18 (2) ◽  
Author(s):  
Aziz Sabbir Husain
Keyword(s):  
Blood Transfusion ◽  
Blood Loss ◽  
Total Knee Replacement ◽  
Tranexamic Acid ◽  
Knee Replacement ◽  
Control Group ◽  
P Value ◽  
Study Group ◽  
Transfusion Rate ◽  
Total Knee

Introduction:  Total knee replacement (TKR) is one of the most common surgeries in orthopedic field. Up to 1/3 of the patients require blood transfusion postoperative. Allogenic transfusion has many side effects. Tranexamic acid (TXA) is a synthetic antifibrinolytic agent. We explore the usage of TXA in reducing blood loss and transfusion rate by injecting it into the knee joint during surgery.  Materials and method: This is a retrospective study done in Hospital Tengku Ampuan Rahimah, Klang. Medical records of patient undergoing TKR between 1 January 2018 till 31 December 2018 were reviewed. Study sample was calculated as 90 patients and divided into 2 groups, one receiving TXA (study) and the other not receiving TXA (control). Post-operative hemoglobin levels and transfusion rate was recorded.  Results: 45 patients in study group (17 male, 28 female) had a mean age of 65.4 years old and 45 patients in control group (24 male, 21 female) had a mean age of 64.2 years old. Mean post-operative hemoglobin drop in study group was 1.08 g/dL vs 1.86 g/dL in control group. Repeated measure ANOVA determined a p value of 0.001 which shows a significant correlation. Total transfusion rate in study group was 1 vs 9 in the control group. Using chi-square test, the p-value was 0.007 which again shows a statistically significant result.  Conclusion: Intra-articular injection of TXA following TKR reduces blood loss and the need for blood transfusion without increasing any complication. This prevents many patients from undergoing a potentially hazardous blood transfusion. A routine usage of intra-articular TXA in patients undergoing TKR is recommended. However a large and well designed RCT is required to investigate the risk and benefits of TXA.

scholarly journals Evaluation of tranexamic acid in reducing blood loss and transfusions in total knee replacement

2019 ◽  
Vol 5 (5) ◽  
pp. 899
Author(s):  
Mirza Atif Baig ◽  
Srujith Kommera
Keyword(s):  
Blood Loss ◽  
Total Knee Replacement ◽  
Tranexamic Acid ◽  
Knee Replacement ◽  
Acid Group ◽  
Control Group ◽  
Blood Transfusions ◽  
Reduce Blood Loss ◽  
Transfusion Requirements ◽  
Total Knee

<p class="abstract"><strong>Background:</strong> Total knee replacement (TKR) is associated with substantial blood loss and thus the need for blood transfusions. Risks and costs of allogenic blood transfusions requires strategies to reduce blood loss in surgery. The objective of this study was to assess the efficacy of tranexamic acid treatment in reducing blood loss and blood transfusion requirements during TKR.</p><p class="abstract"><strong>Methods:</strong> A randomized controlled trial was conducted on 60 patients who were operated for unilateral TKR from January 2016 to January 2019 in Shadan Institute of Medical Sciences. 30 patients were in each control and study groups. In study group 12 mg/kg bolus of tranexamic acid was given as a slow IV dose, 40 minutes before deflation of tourniquet followed by 1.2 mg/kg/hr infusion for 12 hours with standard treatment of hospital and compared to the control group. Later blood loss was compared both intra and post operatively. Fall in haemoglobin after surgery was also compared.<strong></strong></p><p class="abstract"><strong>Results:</strong> Total blood loss in tranexamic acid group was 543.3±184.85<strong> </strong>ml (control group 685.83±176.74 ml) which is statistically significant (p&lt;0.05). Blood loss was markedly decreased in tranexamic acid group (379.16±174 ml in tranexamic acid vs. 513.33±143.89 ml in control group) statistically significant (p&lt;0.05).</p><p class="abstract"><strong>Conclusions:</strong> Tranexamic acid is an effective strategy to reduce blood loss in patients undergoing total knee replacement and thus minimizing the need for blood transfusions.</p>

Topical (Intra-Articular) Tranexamic Acid Reduces Blood Loss and Transfusion Rates Following Total Knee Replacement

2013 ◽  
Vol 95 (21) ◽  
pp. 1961-1968 ◽  
Author(s):  
Sattar Alshryda ◽  
James Mason ◽  
Manesh Vaghela ◽  
Praveen Sarda ◽  
Antoni Nargol ◽  
...  
Keyword(s):  
Blood Loss ◽  
Total Knee Replacement ◽  
Tranexamic Acid ◽  
Knee Replacement ◽  
Total Knee

Tranexamic Acid Effectiveness on the Amount of Bleeding during Surgery and Surgeon’s Satisfaction in Intertrochanteric Fracture Fixation: A Randomized Clinical Trial

2020 ◽  
Author(s):  
Morteza Saeb ◽  
Ali Mousapour ◽  
Alireza Shafiee ◽  
Seyyed Saeed Khabiri ◽  
Roya Safari-Faramani ◽  
...  
Keyword(s):  
Placebo Group ◽  
Blood Loss ◽  
Tranexamic Acid ◽  
Intertrochanteric Fracture ◽  
Intervention Group ◽  
Postoperative Blood Loss ◽  
Control Group ◽  
The Mean ◽  
The Difference ◽  
Fracture Surgery

Background: The purpose of this study was to evaluate the effect of intravenous tranexamic acid (TXA) on the blood loss volume during surgery and surgeon's satisfaction in intertrochanteric fracture surgery. Methods: A total of 62 patients with intertrochanteric fracture were involved in the study and accidentally categorized into two groups. In the control or first group, patients were medicated with placebo (age: 69.2 ± 6.1 years old) and in the second group or intervention, they received 1 g injection of TXA (age: 69.7 ± 6.4 years old). Intraoperative bleeding was measured by the amount of blood in the suction bottle and amount of gauze utilized and postoperative blood loss was measured by the amount of blood in the drain 48 hours after surgery. Also, hemoglobin (Hb) levels were compared before and after surgery. In the end, the surgeon’s satisfaction was measured by Likert scale. Results: The difference in the amount of intra-operative bleeding was significant between the groups (P < 0.050). The mean number of utilized gauze in the intervention group was meaningfully less than the placebo group (P < 0.050). The mean Hb in the control group was considerably inferior to the intervention group (P < 0.050). The respect of patients in need of transfusion in the placebo group was outstandingly superior to the intervention group (P < 0.005). Surgeon satisfaction in the intervention group was considerably greater than the control group (P < 0.050). Conclusion: The use of intravenous TXA during intertrochanteric fracture surgery can reduce hemorrhage during surgery, reduce the need for blood products, and finally improve the surgeon’s satisfaction.

scholarly journals Use of Tranexamic acid is a cost effective method in preventing blood loss during and after total knee replacement

2011 ◽  
Vol 6 (1) ◽  
pp. 22 ◽  
Author(s):  
Yasir J Sepah ◽  
Masood Umer ◽  
Tashfeen Ahmad ◽  
Faria Nasim ◽  
Muhammad Umer Chaudhry ◽  
...  
Keyword(s):  
Blood Loss ◽  
Total Knee Replacement ◽  
Tranexamic Acid ◽  
Knee Replacement ◽  
Cost Effective ◽  
Cost Effective Method ◽  
Total Knee

scholarly journals The role of tranexamic acid in reducing blood loss in total knee replacement

2013 ◽  
Vol 4 (1) ◽  
pp. 36-39 ◽  
Author(s):  
Virender Kumar Gautam ◽  
Balaji Sambandam ◽  
Shailendra Singh ◽  
Prince Gupta ◽  
Rajat Gupta ◽  
...  
Keyword(s):  
Blood Loss ◽  
Total Knee Replacement ◽  
Tranexamic Acid ◽  
Knee Replacement ◽  
Total Knee

scholarly journals Impact of tranexamic acid on coagulation parameters in patients undergoing total knee replacement surgeries under tourniquet: an observational study

2018 ◽  
Vol 6 (4) ◽  
pp. 1144
Author(s):  
Ajit Kumar Singh ◽  
Gagan Kumar Narula ◽  
Bala Chandran Nambiar ◽  
Parvinder Singh Bedi ◽  
Deeparani S. ◽  
...  
Keyword(s):  
Blood Loss ◽  
Total Knee Replacement ◽  
Tranexamic Acid ◽  
Knee Replacement ◽  
Platelet Function ◽  
P Value ◽  
Coagulation Time ◽  
Coagulation Parameters ◽  
Total Knee ◽  
Activated Coagulation Time

Background: A growing body of evidence has shown Tranexamic Acid (TXA) is effective in decreasing perioperative blood loss and transfusion requirements in both primary and revision joint arthroplasty. TXA is a synthetic drug which limits blood loss through inhibition of fibrinolysis and clot degradation. It helps reduce requirement of colloids and crystalloids and hence provides better haemodynamic stability. The aim of this study was to detect the effect of tranexamic acid on coagulation parameters and effect on bleeding in knee replacement surgeries performed under tourniquet.Methods: Patients undergone surgeries of Total Knee Replacement (TKR) performed under tourniquet were included in the study. A single dosage of 20 mg/kg per body weight of tranexamic acid was administered after application of a tourniquet. Three times blood sample was collected, and coagulation parameters were recorded and compared. The first sample was collected at the time of TXA injection and application of a tourniquet, second after 4 hours and third after 24 hours post TXA injection. Coagulation parameters noted were analyzed using Statistical analysis by SPSS software. All parameters were compared in relation to baseline i.e. at the time of TXA injection.Results: On comparison of demographic profile, morbidity, sofa score and hemodynamic parameters there was the insignificant difference (P > 0.05). Repeated measures of ANOVA at 95% Confidential Interval P value was 0.000 which is less than the significant level that is 0.05 so that value of Platelet Function (PF), Activated Coagulation Time (ACT) and Clot Rate (CR) at 0 hrs, 04 hrs and 24 hrs was statistically significant. Correlation between blood loss and difference of the value of ACT at 0 hrs and 04 hrs is a small negative correlation but statistically nonsignificant (P value is 0.359).Conclusions: After TXA administration there is a change in coagulation parameters like an Activated Coagulation Time (ACT), Platelet Function (PF), and Clot Rate (CR) measured at three intervals, hence it can be a guide to detect early derangement in the coagulation profile in a patient undergoing knee replace surgery. TXA correlation between blood loss with changes in parameters of coagulation i.e. ACT, PF and CR were noted but not significant.

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