抄録
Objective: This prospective randomized study was undertaken to compare the effect of postoperative bleeding control after total knee arthroplasty (TKA) by the drainage clamp method with or without intra-articular drug administration in the immediate postoperative period.
Methods: From 44 consecutive knee surgeries in 42 patients who underwent primary TKA, 12 patients were excluded from the study for the following reasons: three patients required release of tourniquet intraoperatively because of prolonged surgery, eight patients were anemic preoperatively and who were at an increased risk for blood transfusion, and one patient who had received combined anticoagulation therapy perioperatively. Thirty-two knees in 31 patients (average age, 74 years; range, 61-89 years) were included in this study and they were divided into three groups; lidocaine-epinephrine or tranexamic acid administered into the TKA immediately after surgery constituted groups A and B respectively, whereas group C received no drug administration as a control. After drug administration, the drainage tube remained clamped for two hours postoperatively, which was subsequently opened until its removal on the second postoperative day. Total drainage fluid amounts and the total amount of postoperative bleeding were calculated from the changes of serum hemoglobin level and these were compared statistically among the three groups.
Results: The total drainage fluid amounts in group A, B and C were 788±358ml, 568±284ml and 836±333ml, respectively. The difference between group B and C was statistically significant (p < 0.05). The total amounts of postoperative bleeding in group A, B and C were 1538±329ml, 852±209ml and 1519±195ml, respectively. There was a significantly decreased amount of bleeding in group B compared with groups A and C (p < 0.05).
Conclusion: Immediate postoperative administration of tranexamic acid into total knee arthroplasties was shown to be effective in the control of postoperative bleeding, compared with lidocaine-epinephrine administration and control.
