title: A randomized trial of the effect of low dose epinephrine infusion in addition to tranexamic acid on blood loss during total hip arthroplasty.
abstract: 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.
  
  
  CONCLUSIONS
  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.
  
  
  BACKGROUND
  NCT 01708642.
authors.affiliation: Section of Surgical Pathophysiology, Rigshospitalet, Copenhagen, Denmark Lundbeck Foundation Centre for Fast-track Hip and Knee Arthroplasty, Copenhagen, Denmark oeivind.jans@regionh.dk.
authors.forename: Ø
authors.initials: Ø
authors.lastname: Jans
authors.affiliation: Department of Anaesthesia, Gentofte Hospital, Copenhagen, Denmark.
authors.forename: U
authors.initials: U
authors.lastname: Grevstad
authors.affiliation: Department of Anaesthesia, Vejle Hospital, Vejle, Denmark.
authors.forename: H
authors.initials: H
authors.lastname: Mandøe
authors.affiliation: Section of Surgical Pathophysiology, Rigshospitalet, Copenhagen, Denmark Lundbeck Foundation Centre for Fast-track Hip and Knee Arthroplasty, Copenhagen, Denmark.
authors.forename: H
authors.initials: H
authors.lastname: Kehlet
authors.affiliation: Lundbeck Foundation Centre for Fast-track Hip and Knee Arthroplasty, Copenhagen, Denmark Section for Transfusion Medicine, Rigshospitalet, Copenhagen, Denmark.
authors.forename: P I
authors.initials: PI
authors.lastname: Johansson
mesh_terms: D000316:Adrenergic alpha-Agonists / Q000008:administration & dosage / Q000494:pharmacology*; D000368:Aged; D000933:Antifibrinolytic Agents / Q000494:pharmacology; D019644:Arthroplasty, Replacement, Hip; D001777:Blood Coagulation / Q000187:drug effects; D016063:Blood Loss, Surgical / Q000706:statistics & numerical data*; D004311:Double-Blind Method; D004837:Epinephrine / Q000008:administration & dosage / Q000494:pharmacology*; D005260:Female; D006801:Humans; D007262:Infusions, Intravenous; D008297:Male; D014148:Tranexamic Acid / Q000494:pharmacology*; D016896:Treatment Outcome
chemical_list: D000316:Adrenergic alpha-Agonists; D000933:Antifibrinolytic Agents; D014148:Tranexamic Acid; D004837:Epinephrine
keywords: arthroplasty; blood loss; epinephrine; hip replacement, total