A randomized trial of the effect of low dose epinephrine infusion in addition to tranexamic acid on blood loss during total hip arthroplasty
| Autor: | Pär I. Johansson, Øivind Jans, Ulrik Grevstad, Henrik Kehlet, Hans Mandøe |
|---|---|
| Rok vydání: | 2016 |
| Předmět: |
Male
Arthroplasty Replacement Hip medicine.medical_treatment Blood Loss Surgical 030204 cardiovascular system & hematology law.invention 0302 clinical medicine Randomized controlled trial law 030202 anesthesiology Antifibrinolytic agent Infusion Procedure Adrenergic alpha-Agonists/administration & dosage Tranexamic Acid/pharmacology blood loss Infusions Intravenous Saline hip replacement total Intraoperative Hemorrhage Antifibrinolytic Agents Treatment Outcome Antifibrinolytic Agents/pharmacology Epinephrine Tranexamic Acid Anesthesia Female Adrenergic alpha-Agonists Tranexamic acid Total hip arthroplasty medicine.drug medicine.medical_specialty Blood Loss Surgical/statistics & numerical data Placebo 03 medical and health sciences Blood loss Double-Blind Method medicine Humans Epinephrine/administration & dosage epinephrine arthroplasty blood loss epinephrine hip replacement total management transfusion metaanalysis replacement Anesthesiology Blood Coagulation Aged business.industry Arthroplasty Surgery Clinical trial Anesthesiology and Pain Medicine Blood Coagulation/drug effects arthroplasty business |
| Zdroj: | Jans, Ø, Grevstad, U, Mandoe, H, Kehlet, H & Johansson, P I 2016, ' A randomized trial of the effect of low dose epinephrine infusion in addition to tranexamic acid on blood loss during total hip arthroplasty ', British Journal of Anaesthesia, vol. 116, no. 3, pp. 357-362 . https://doi.org/10.1093/bja/aev408 |
| ISSN: | 0007-0912 |
| Popis: | Background Total hip arthroplasty (THA) is associated with both intraoperative and postoperative blood loss resulting in anaemia and, in some patients, transfusion of red blood cells. Epinephrine enhances coagulation by several mechanisms. We evaluated the effect of intraoperative low dose infusion of epinephrine on intraoperative and early postoperative blood loss. Methods After consent, 106 subjects undergoing THA under spinal anaesthesia were randomly assigned to receive an i.v. infusion of either epinephrine 0.05 µg kg−1 min−1 or placebo (saline 0.9%) during the entire surgical procedure. Intraoperative tranexamic acid (TXA) was administered to all subjects. The primary outcome was intraoperative blood loss directly measured by drains and weighing swabs. Secondary outcome was total blood loss at 24 h postoperatively calculated using the Gross formula. Results Of 106 subjects randomized, 6 were excluded, leaving 100 subjects for analyses. Mean duration of surgery was 58 (21) min. Intraoperative blood loss was 343 (95% CI 300–386) ml in the epinephrine group compared with 385 (353–434) ml in the placebo group, P + 0.228. 24 h blood loss was 902 (800–1004) ml in the epinephrine group compared with 1080 (946–1220) ml in the placebo group, P + 0.038. Conclusion In subjects also receiving TXA, intraoperative low dose epinephrine infusion did not reduce intraoperative blood loss in THA but calculated 24 h blood loss was reduced by 180 ml compared with placebo. Further studies on low dose epinephrine in patients at high risk of significant bleeding are warranted. Clinical trial registration NCT 01708642. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|