title: Reduced blood loss after total knee arthroplasty with local injection of bupivacaine and epinephrine.
abstract: Our goal was to determine by direct measurement of drain output whether intraoperative injection of bupivacaine with epinephrine significantly reduces postoperative blood loss in total knee arthroplasty (TKA). The study and control groups were primary TKAs performed by 1 surgeon using a single-cemented TKA design and a consistent postoperative protocol. The study group comprised 37 sequential TKAs injected intraoperatively with bupivacaine and epinephrine (one-third pericapsular, two-thirds peri-incisional). The control group included 71 sequential TKAs. The study group had 32% (95% confidence interval, 11%-48%), or 195 mL, less drain output (P = .006). There were no statistically significant differences in the transfusion rate or bleeding indices. Control and study groups were comparable regarding tourniquet times, intraoperative soft-tissue releases, preoperative anticoagulant use, and overall postoperative complications. Our study demonstrated a statistically significant decrease in TKA postoperative drain output with intraoperative injection of bupivacaine with epinephrine.
authors.affiliation: Department of Orthopaedic Surgery, University of Utah School of Medicine, Salt Lake City, UT 84108, USA.
authors.forename: Lucas A
authors.initials: LA
authors.lastname: Anderson
authors.forename: Gregory M
authors.initials: GM
authors.lastname: Engel
authors.forename: James D
authors.initials: JD
authors.lastname: Bruckner
authors.forename: Gregory J
authors.initials: GJ
authors.lastname: Stoddard
authors.forename: Christopher L
authors.initials: CL
authors.lastname: Peters
mesh_terms: D000368:Aged; D000779:Anesthetics, Local / Q000008:administration & dosage; D019645:Arthroplasty, Replacement, Knee / Q000379:methods*; D016063:Blood Loss, Surgical / Q000517:prevention & control*; D002045:Bupivacaine / Q000008:administration & dosage*; D016022:Case-Control Studies; D004359:Drug Therapy, Combination; D004837:Epinephrine / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D015552:Injections, Intralesional / Q000379:methods; D007432:Intraoperative Period; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome; D014662:Vasoconstrictor Agents / Q000008:administration & dosage*
chemical_list: D000779:Anesthetics, Local; D014662:Vasoconstrictor Agents; D002045:Bupivacaine; D004837:Epinephrine