title: No difference in total blood loss, haemoglobin and haematocrit between continues and intermittent wound drainage after total knee arthroplasty.
abstract: OBJECTIVE
  The purpose of this prospective randomized study was to compare the visible, hidden, total blood loss and postoperative haemodynamic change of 4-h clamping and nonclamping of the drain after TKA. The hypothesis in the present study was that intermittent drain clamping with injection of diluted epinephrine solution would decrease the visible, hidden blood loss and reduction of postoperative haemoglobin or haematocrit change after TKA.
  
  
  METHODS
  From January 2010 to January 2011, 100 TKAs were performed at our hospital. In group I (50 knees), drainage was clamped for the first 4 postoperative hours with injection of diluted epinephrine solution. In group II (50 knees), drainage was not clamped without injection of diluted epinephrine solution. Two drains with an external diameter of 3.2 mm were inserted into the knee joint. We checked the amount of drainage recorded at 6, 12, 24, and 48 h postoperatively. Also, we checked the haemoglobin and haematocrit on the preoperation, first, 5th and 10th postoperative days. We analysed the transfusion rate, the possible adverse issues with clamping drainage, and the range of motion of the knee.
  
  
  RESULTS
  The mean total bloody drainage was significantly less in group I than group II (560.7 ± 249.9 mL vs 978.3 ± 327.5 mL) (p < 0.001). The decrease of haemoglobin and haematocrit after surgery was not significant between the two groups (n.s.). The hidden blood loss was significantly more in group I than group II (541.1 ± 439.4 mL vs 32.1 ± 21.9 mL) (p < 0.001). So, total blood loss showed no significant difference between the two groups (1,101.8 ± 373.6 mL vs 1,010.4 ± 385.9 mL) (n.s.). The postoperative range of motion and transfusion rate between the two groups were not significant (n.s.). But immediate wound problem, such as oozing, was significantly more in group I (p < 0.001).
  
  
  CONCLUSIONS
  It is not necessary to perform the intermittent drain clamping with injection of the diluted epinephrine solution in TKA because there is no impact on the postoperative haemoglobin and haematocrit. If anything, the intermittent drain clamping with injection of the diluted epinephrine solution increased the hidden blood loss and immediate wound problem than nonclamping without injection of the diluted epinephrine solution.
authors.affiliation: Department of Orthopaedic Surgery, Murup Hospital, 2-52, 3 Ga Jungang-dong, Masanhappo-gu, Changwon-si, Gyeongnam, 631-423, South Korea.
authors.forename: Woon-Hwa
authors.initials: WH
authors.lastname: Jung
authors.forename: Chung-Woo
authors.initials: CW
authors.lastname: Chun
authors.forename: Ji-Hoon
authors.initials: JH
authors.lastname: Lee
authors.forename: Jae-Hun
authors.initials: JH
authors.lastname: Ha
authors.forename: Ji-Hye
authors.initials: JH
authors.lastname: Kim
authors.forename: Jae-Heon
authors.initials: JH
authors.lastname: Jeong
mesh_terms: D000368:Aged; D019645:Arthroplasty, Replacement, Knee; D016063:Blood Loss, Surgical; D001803:Blood Transfusion / Q000706:statistics & numerical data; D003250:Constriction; D004322:Drainage; D004837:Epinephrine / Q000008:administration & dosage; D005260:Female; D006400:Hematocrit; D006454:Hemoglobins / Q000032:analysis*; D006801:Humans; D008297:Male; D020370:Osteoarthritis, Knee / Q000601:surgery*; D011446:Prospective Studies; D016896:Treatment Outcome; D014662:Vasoconstrictor Agents / Q000008:administration & dosage
chemical_list: D006454:Hemoglobins; D014662:Vasoconstrictor Agents; D004837:Epinephrine