PROSPECTIVE RANDOMIZED EVALUATION OF THE IMPACT OF MULTIMODAL ANALGESIA AND TRANEXAMIC ACID ON POSTOPERATIVE PAIN AND BLOOD LOSS IN KNEE ARTHROPLASTY PATIENTS
DOI:
https://doi.org/10.54112/bcsrj.v2024i1.1389Keywords:
Post-operative blood loss, Intra-articular injection, tranexamic acid, cocktail, total knee replacementAbstract
The most prevalent type of arthritis and a major contributor to disability is osteoarthritis. One of the most successful surgical treatments is total knee arthroplasty (TKA), which improves function and relieves pain in most patients. Objectives: The aim of this study is to evaluate the effects of intra-articular tranexamic acid and multimodal cocktail on postoperative blood loss and pain in patients undergoing total knee replacement. Methods: Enrolled were ninety-six male or female individuals with knee osteoarthritis who intended to have a total knee replacement. Group A received conventional anaesthetic medications only; tranexamic acid was not administered. Patients in Group B received an intraarticular injection of tranexamic acid weighing three grammes. Patients in Group C received a multimodal cocktail consisting of bupivacaine, tramadol, and ketorolac. Following TKA, patients had a 72-hour follow-up period. For 72 hours, blood loss and a pain score were recorded every 24 hours. Results: Patients in the cocktail group were 50.22±9.63 years old, those in the TXA group were 52.31±14.69 years old, and those in the control group were 48.92±13.22 years old. In three groups, the male-to-female ratios were, respectively, 11:21, 14:18, and 10:22. Within the first 72 hours, the control group lost 1030.1±177.27ml of blood, the TXA group lost 453.7±80.4ml, and the cocktail group lost 607.7±122.5ml. There was a significant difference (p<0.05) between TXA and cocktail groups and in all three groups. In the control group, the mean postoperative pain score was 4.4±2.3, in the TXA group it was 2.4±1.5, and in the cocktail group, it was 1.8±1.0 over the first 72 hours. The TXA and cocktail groups showed negligible differences (p>0.05), whereas the three groups showed substantial differences (p<0.05). Conclusion: Compared to the control group, the use of an intraarticular TXA injection was found to be effective in lowering blood loss. Although the multimodal cocktail allowed for better pain management than the other two groups.
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References
Neogi T. The epidemiology and impact of pain in osteoarthritis. Osteoarthritis Cartilage 2013;21(9):1145-53.
Plotnikoff R, Karunamuni N, Lytvyak E, Penfold C, Schopflocher D, Imayama I, et al. Osteoarthritis prevalence and modifiable factors: a population study. BMC Public Health 2015 2015/11/30;15(1):1195.
Pal C, Singh P, Chaturvedi S, Pruthi K, Vij A. Epidemiology of knee osteoarthritis in India and related factors. Indian Journal of Orthopaedics [Original Article] 2016 September 1, 2016;50(5):518-22.
Schroer WC, Berend KR, Lombardi AV, Barnes CL, Bolognesi MP, Berend ME, et al. Why Are Total Knees Failing Today? Etiology of Total Knee Revision in 2010 and 2011. The Journal of Arthroplasty 2013 2013/09/01/;28(8, Supplement):116-9.
Makridis K, Karachalios T. A Brief History of Total Knee Arthroplasty. In: Karachalios T, editor. Total Knee Arthroplasty: Long Term Outcomes. London: Springer London; 2015. p. 1-6.
Itokazu M, Minoda Y, Ikebuchi M, Mizokawa S, Ohta Y, Nakamura H. Anatomical landmarks of the distal femoral condyles are not always parallel to the tibial bone cut surface in flexion during total knee arthroplasty. The Knee 2016;23(4):725-9.
Vernon T, Morgan M, Morrison C. Bad blood: A coagulopathy associated with trauma and massive transfusion review. Acute medicine & surgery 2019 Jul;6(3):215-22.
Kodali S, Holmes CE, Tipirneni E, Cahill CR, Goodwin AJ, Cushman M. Successful management of refractory bleeding in liver failure with tranexamic acid: Case report and literature review. Research and practice in thrombosis and haemostasis 2019;3(3):424-8.
Choi WS, Irwin MG, Samman N. The effect of tranexamic acid on blood loss during orthognathic surgery: a randomized controlled trial. Journal of oral and maxillofacial surgery : official journal of the American Association of Oral and Maxillofacial Surgeons 2009 Jan;67(1):125-33.
Pandove PK, Singla RL, Mittal P, Mahajan N, Kumar A. Role of Tranexamic Acid on Blood Loss in Laparoscopic Cholecystectomy. Nigerian journal of surgery : official publication of the Nigerian Surgical Research Society 2017 Jul-Dec;23(2):111-4.
Oremus K. Tranexamic acid for the reduction of blood loss in total knee arthroplasty. Ann Transl Med 2015;3(Suppl 1):S40-S.
Tammachote N, Kanitnate S, Manuwong S, Yakumpor T, Panichkul P. Is pain after TKA better with periarticular injection or intrathecal morphine? Clinical orthopaedics and related research 2013;471(6):1992-9.
Dalury DF. A state-of-the-art pain protocol for total knee replacement. Arthroplast Today 2016;2(1):23-5.
Ashraf A, Raut VV, Canty SJ, McLauchlan GJ. Pain control after primary total knee replacement. A prospective randomised controlled trial of local infiltration versus single shot femoral nerve block. The Knee 2013;20(5):324-7.
Kurosaka K, Tsukada S, Seino D, Morooka T, Nakayama H, Yoshiya S. Local Infiltration Analgesia Versus Continuous Femoral Nerve Block in Pain Relief After Total Knee Arthroplasty: A Randomized Controlled Trial. The Journal of arthroplasty 2016;31(4):913-7.
Lin P, Hsu C, Huang C, Chen W, Wang J. The blood-saving effect of tranexamic acid in minimally invasive total knee replacement: is an additional pre-operative injection effective? The Journal of bone and joint surgery British volume 2012;94(7):932-6.
Yen S-H, Lin P-C, Chen B, Huang C-C, Wang J-W. Topical Tranexamic Acid Reduces Blood Loss in Minimally Invasive Total Knee Arthroplasty Receiving Rivaroxaban. BioMed Research International 2017;2017:8.
Ponnusamy KE, Kim TJ, Khanuja HS. Perioperative blood transfusions in orthopaedic surgery. The Journal of bone and joint surgery American volume 2014;96(21):1836-44.
Henry DA, Carless PA, Moxey AJ, O'Connell D, Stokes BJ, Fergusson DA, et al. Anti-fibrinolytic use for minimising perioperative allogeneic blood transfusion. The Cochrane database of systematic reviews 2011(3):Cd001886.
Poeran J, Rasul R, Suzuki S, Danninger T, Mazumdar M, Opperer M, et al. Tranexamic acid use and postoperative outcomes in patients undergoing total hip or knee arthroplasty in the United States: retrospective analysis of effectiveness and safety. BMJ (Clinical research ed) 2014;349:g4829.
Alshryda S, Sukeik M, Sarda P, Blenkinsopp J, Haddad FS, Mason JM. A systematic review and meta-analysis of the topical administration of tranexamic acid in total hip and knee replacement. The bone & joint journal 2014;96-b(8):1005-15.
Maniar RN, Kumar G, Singhi T, Nayak RM, Maniar PR. Most effective regimen of tranexamic acid in knee arthroplasty: a prospective randomized controlled study in 240 patients. Clinical orthopaedics and related research 2012;470(9):2605-12.
Kim TK, Chang CB, Kang YG, Seo ES, Lee JH, Yun JH, et al. Clinical value of tranexamic acid in unilateral and simultaneous bilateral TKAs under a contemporary blood-saving protocol: a randomized controlled trial. Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA 2014;22(8):1870-8.
Kakar PN, Gupta N, Govil P, Shah V. Efficacy and Safety of Tranexamic Acid in Control of Bleeding Following TKR: A Randomized Clinical Trial. Indian journal of anaesthesia 2009;53(6):667-71.
Shi LJ, Gao FQ, Sun W, Wang WG, Cheng LM, Guo WS. Cocktail therapy reduces hidden blood loss after total knee arthroplasty. Chinese Journal of Tissue Engineering Research 2017;21:329-34.
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