Reducing perioperative blood loss in patients undergoing total hip arthroplasty.
In this prospective, randomised, double-blind study, we investigated the effect of epidural anaesthesia and an antifibrinolytic agent, Aprotinin (500,000 KIU in bolus before surgery and 500,000 KIU h(-1) in drip form during surgery), on intra and postoperative blood loss and transfusion requirements in total hip arthroplasty. Sixty patients were allocated randomly to four groups (A: epidural + general anesthesia + Aprotinin, B: epidural + general anesthesia + placebo (equal volume), C: general anaesthesia + Aprotinin, D: general anaesthesia + placebo). Postoperative analgesia: epidural analgesia in groups A and B, systemic analgesia with opiates in groups C and D. Blood loss during surgery was monitored and salvaged with the Compact-A Dideco, and postoperative blood loss with the BT 797 Recovery Dideco for the first 24 hours. Perioperative blood loss, frequency and quantity of transfusions were significantly higher in group D (p<0.0001). Total blood loss was reduced by 31.3% by epidural anaesthesia, 20.4% by Aprotinin and 51.4% using a combination of the two techniques.
D'Ambrosio
A
A
1st Service of Anaesthesia and Intensive Care, I.R.C.C.S. Casa Sollievo Della Sofferenza Hospital, S. Giovanni Rotondo (Foggia), Italy.
Borghi
B
B
Damato
A
A
D'Amato
G
G
Antonacci
D
D
Valeri
F
F
D000368:Aged; D000767:Anesthesia, Epidural; D000768:Anesthesia, General; D007611:Aprotinin / Q000008:administration & dosage*; D019644:Arthroplasty, Replacement, Hip; D016063:Blood Loss, Surgical / Q000517:prevention & control*; D004311:Double-Blind Method; D005260:Female; D006454:Hemoglobins / Q000032:analysis; D006490:Hemostatics / Q000008:administration & dosage*; D006801:Humans; D008297:Male; D008875:Middle Aged; D019106:Postoperative Hemorrhage / Q000517:prevention & control; D011446:Prospective Studies
D006454:Hemoglobins; D006490:Hemostatics; D007611:Aprotinin