Effects of subperiosteal injection of tranexamic acid combined with ropivacaine in total knee arthroplasty

doi:10.3877/cma.j.issn.1674-134X.2022.03.003

Abstract

Abstract:

Objective

To investigate the effect of subperiosteal injection of tranexamic acid (TXA) combined with ropivacaine in unilateral total knee arthroplasty (TKA).

Methods

A retrospective analysis was carried out on 154 patients with severe knee osteoarthritis who underwent unilateral TKA in the No.1 Department of Orthopaedic Surgery, Jieyang People's Hospital from January 2017 to January 2021. Inclusion criteria: age from 60 to 80 years with severe knee osteoarthritis, undergoing unilateral TKA only; exclusion criteria: allergy to TXA or ropivacaine, abnormal blood parameters, or data missing. The patients were divided into two groups. Among them, 80 patients were injected with one gram TXA and 100 mg ropivacaine around the joint cavity during TKA operation (the traditional group), and subperiosteal injection of one gram TXA and 100 mg ropivacaine was applied at the distal femur and proximal tibia in 74 patients (the modified group). The intraoperative blood loss, total blood loss, hemoglobin (Hb) decreasing in three days after surgery, the visual analogue score (VAS) on one, two, three, seven, and 14 days after the surgery, the incidence of postoperative complications, operation time, and hospitalization time were compared between the two groups. Statistical analysis was performed using t test and chi square test.

Results

No obvious complication occurred in 154 patients. There was no statistically significant difference in the general condition, preoperative Hb, preoperative VAS score, operation time, or hospitalization time between the two groups (all P>0.05). The amounts of blood loss of the two groups showed no statistically significant difference (P>0.05); the total blood loss (t=5.476, P<0.05) and the decrease of Hb three days after the operation (t=3.705, P<0.05) in the modified group were lower than those in the traditional group. The repeated measures ANOVA on the VAS scores in the resting state and joint flexion state of two groups on one, two, three, seven, and 14 days showed that the modified group reported less postoperative pain than the conventional group both at rest (F=13.512, P<0.001) and in knee flexion (F=18.185, P<0.001).

Conclusion

Subperiosteal injection of TXA and ropivacaine can effectively reduce blood loss during TKA surgery and significantly reduce early postoperative pain.

Key words: Arthroplasty, replacement, knee, Tranexamic acid, Ropivacaine, Periosteum

Yongsheng Lin, Zhibin Lin, Yang Li, Hong Chen, Songliang Chen. Effects of subperiosteal injection of tranexamic acid combined with ropivacaine in total knee arthroplasty[J]. Chinese Journal of Joint Surgery(Electronic Edition), 2022, 16(03): 273-277.

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References 22

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项目	传统组	改良组	统计值	P值
例数	80	74
性别(男/女)	27/53	24/50	χ²＝0.030	>0.05
年龄[岁，(±s)]	70.8±8.0	71.5±8.0	t＝0.535	>0.05
BMI[kg/m²，(±s)]	24.1±1.7	23.9±1.8	t＝0.461	>0.05
手术时间[min，(±s)]	64.5±9.0	64.13±8.9	t＝0.271	>0.05
住院天数[d，(±s)]	7.0±1.4	6.9±1.5	t＝0.376	>0.05
术前Hb[g/L，(±s)]	129.0±11.0	131.6±11.2	t＝1.442	>0.05
术前Hct[%，(±s)]	40.3±2.3	40.6±2.7	t＝0.728	>0.05
术前VAS得分(±s)	7.1±1.4	7.3±1.4	t＝0.573	>0.05

项目	传统组	改良组	统计值	P值
例数	80	74
性别(男/女)	27/53	24/50	χ²＝0.030	>0.05
年龄[岁，(±s)]	70.8±8.0	71.5±8.0	t＝0.535	>0.05
BMI[kg/m²，(±s)]	24.1±1.7	23.9±1.8	t＝0.461	>0.05
手术时间[min，(±s)]	64.5±9.0	64.13±8.9	t＝0.271	>0.05
住院天数[d，(±s)]	7.0±1.4	6.9±1.5	t＝0.376	>0.05
术前Hb[g/L，(±s)]	129.0±11.0	131.6±11.2	t＝1.442	>0.05
术前Hct[%，(±s)]	40.3±2.3	40.6±2.7	t＝0.728	>0.05
术前VAS得分(±s)	7.1±1.4	7.3±1.4	t＝0.573	>0.05

组别	例数	术中出血量(ml)	总失血量(ml)	血红蛋白下降值(g/L)
传统组	80	72±16	532±105	20±6
改良组	74	73±19	629±116	17±6
t值		0.438	5.476	3.705
P值		>0.05	<0.001	<0.001

组别	例数	术中出血量(ml)	总失血量(ml)	血红蛋白下降值(g/L)
传统组	80	72±16	532±105	20±6
改良组	74	73±19	629±116	17±6
t值		0.438	5.476	3.705
P值		>0.05	<0.001	<0.001

组别	例数	术后1 d	术后2 d	术后3 d	术后7 d	术后14 d
传统组	80	6.1±1.2	6.1±1.1	5.8±1.0	3.3±1.2	2.3±0.8
改良组	74	5.7±1.3	5.6±1.2	5.1±1.1	3.2±1.1	2.2±0.9
F值		13.512
P值		<0.001

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