Skip to main content
Erschienen in: Archives of Orthopaedic and Trauma Surgery 1/2012

01.01.2012 | Orthopaedic Surgery

Reactionary haemorrhage reduction with adrenaline infiltration in proximal tibial osteotomy: a randomized clinical study of safety and efficacy

verfasst von: Alfred O. Ogbemudia, Anire Bafor, Loius West-Osemwengie

Erschienen in: Archives of Orthopaedic and Trauma Surgery | Ausgabe 1/2012

Einloggen, um Zugang zu erhalten

Abstract

Introduction

In corrective osteotomy, wound closure is undertaken with or without deflation of the tourniquet. Hypoxia from the tourniquet causes vasodilatation associated with reactionary haemorrhage and reduced haemoglobin concentration and possibly increased blood transfusion rate. Reactionary haemorrhage and related transfusion need can be reduced through vasoconstriction from adrenaline infiltration.

Method

A randomized, placebo-controlled trial was done to compare adrenaline–saline solution to normal saline in the control of reactionary haemorrhage after proximal tibial osteotomy in children. Sixty-one eligible patients were divided into two groups and had corrective osteotomy under the same surgeon over a period of 7 years.

Results

Wound infiltration with adrenaline–saline solution 1:200,000 and normal saline was done in groups one and two, respectively. No intra-operative adverse effect was recorded. There was a 20% incidence of superficial wound dehiscence in group 1 and none in controls. The mean volume of blood in drains in the first 24 h post operation was 85 ml in group 1 and 225 ml in group 2 (p < 0.001). The mean haemoglobin level on the fifth day post operation was 11.8 g/dl in group 1 and 8.2 g/dl in group 2 (p < 0.001). There was no blood transfusion in group one while two patients were transfused in group two.

Conclusion

In conclusion, wound infiltration with adrenaline was effective in reducing the extent of reactionary haemorrhage and post-operative drop in haemoglobin concentration. There was no significant difference in the transfusion rates in both groups.
Literatur
1.
Zurück zum Zitat Shiga T, Wajima Z, Inoue T, Sakamoto A (2005) Aprotinin in major orthopedic surgery: a systematic review of randomized controlled trials. Anesth Analg 101:1602–1607PubMedCrossRef Shiga T, Wajima Z, Inoue T, Sakamoto A (2005) Aprotinin in major orthopedic surgery: a systematic review of randomized controlled trials. Anesth Analg 101:1602–1607PubMedCrossRef
2.
Zurück zum Zitat Lauder GR (2007) Pre-operative predeposit autologous donation in children presenting for elective surgery: a review. Transfus Med 17:75–82PubMedCrossRef Lauder GR (2007) Pre-operative predeposit autologous donation in children presenting for elective surgery: a review. Transfus Med 17:75–82PubMedCrossRef
3.
Zurück zum Zitat Dunn CJ, Goa KL (1999) Tranexamic acid: a review of its use in surgery and other indications. Drugs 57:1005–1032PubMedCrossRef Dunn CJ, Goa KL (1999) Tranexamic acid: a review of its use in surgery and other indications. Drugs 57:1005–1032PubMedCrossRef
4.
Zurück zum Zitat Lehmann M, Hasler K, Bergdolt E, Keul J (1986) Alpha-2-adrenoreceptor density on intact platelets and adrenaline-induced platelet aggregation in endurance- and nonendurance-trained subjects. Int J Sports Med 7:172–176PubMedCrossRef Lehmann M, Hasler K, Bergdolt E, Keul J (1986) Alpha-2-adrenoreceptor density on intact platelets and adrenaline-induced platelet aggregation in endurance- and nonendurance-trained subjects. Int J Sports Med 7:172–176PubMedCrossRef
5.
Zurück zum Zitat Yun-Choi HS, Park KM, Pyo MK (2000) Epinephrine induced platelet aggregation in rat platelet-rich plasma. Thromb Res 100:511–518PubMedCrossRef Yun-Choi HS, Park KM, Pyo MK (2000) Epinephrine induced platelet aggregation in rat platelet-rich plasma. Thromb Res 100:511–518PubMedCrossRef
6.
Zurück zum Zitat Thomas SS, Srivastava S, Nancarrow JD, Mohmand MH (1999) Dilute adrenaline infiltration and reduced blood loss in reduction mammaplasty. Ann Plast Surg 43:127–131PubMed Thomas SS, Srivastava S, Nancarrow JD, Mohmand MH (1999) Dilute adrenaline infiltration and reduced blood loss in reduction mammaplasty. Ann Plast Surg 43:127–131PubMed
7.
Zurück zum Zitat Oxner RB, Simmonds NJ, Gertner DJ, Nightingale JM, Burnham WR (1992) Controlled trial of endoscopic injection treatment for bleeding from peptic ulcers with visible vessels. Lancet 339(8799):966–968PubMedCrossRef Oxner RB, Simmonds NJ, Gertner DJ, Nightingale JM, Burnham WR (1992) Controlled trial of endoscopic injection treatment for bleeding from peptic ulcers with visible vessels. Lancet 339(8799):966–968PubMedCrossRef
8.
Zurück zum Zitat Morris T, Appleby R (2005) Retardation of wound healing by procaine. Br J Surg 67:391–392CrossRef Morris T, Appleby R (2005) Retardation of wound healing by procaine. Br J Surg 67:391–392CrossRef
9.
Zurück zum Zitat Ogbemudia AO, Bafor A, Edomwonyi E, Ogbemudia PE (2008) Sterile pneumatic tourniquet adapted from the aneroid sphygmomanometer: technique and results. Niger J Ortho Trauma 7:45–47 Ogbemudia AO, Bafor A, Edomwonyi E, Ogbemudia PE (2008) Sterile pneumatic tourniquet adapted from the aneroid sphygmomanometer: technique and results. Niger J Ortho Trauma 7:45–47
10.
Zurück zum Zitat Gasparini G, Papaleo P, Pola P, Cerciello S, Pola E, Fabbriciani C (2006) Local infusion of norepinephrine reduces blood losses and need of transfusion in total knee arthroplasty. Int Orthop 30:253–256PubMedCrossRef Gasparini G, Papaleo P, Pola P, Cerciello S, Pola E, Fabbriciani C (2006) Local infusion of norepinephrine reduces blood losses and need of transfusion in total knee arthroplasty. Int Orthop 30:253–256PubMedCrossRef
11.
Zurück zum Zitat Tsumara N, Yoshiya S, Chin T, Shiba R, Kohso K, Doita M (2006) A prospective comparison of clamping the drain or post-operative salvage of blood in reducing blood loss after total knee arthroplasty. J Bone Joint Surg [Br] 88:49–53CrossRef Tsumara N, Yoshiya S, Chin T, Shiba R, Kohso K, Doita M (2006) A prospective comparison of clamping the drain or post-operative salvage of blood in reducing blood loss after total knee arthroplasty. J Bone Joint Surg [Br] 88:49–53CrossRef
12.
Zurück zum Zitat Mesa-Ramos F, Mesa-Ramos M, Maquieira-Canosa C, Carpintero P (2008) Predictors for blood transfusion following total knee arthroplasty: a prospective randomised study. Acta Orthop Belg 74(1):83–89PubMed Mesa-Ramos F, Mesa-Ramos M, Maquieira-Canosa C, Carpintero P (2008) Predictors for blood transfusion following total knee arthroplasty: a prospective randomised study. Acta Orthop Belg 74(1):83–89PubMed
13.
Zurück zum Zitat Padala PR, Rouholamin E, Mehta RL (2004) The role of drains and tourniquets in primary total knee replacement: a comparative study of TKR performed with drains and tourniquet versus no drains and adrenaline and saline infiltration. J Knee Surg 17(1):24–27PubMed Padala PR, Rouholamin E, Mehta RL (2004) The role of drains and tourniquets in primary total knee replacement: a comparative study of TKR performed with drains and tourniquet versus no drains and adrenaline and saline infiltration. J Knee Surg 17(1):24–27PubMed
14.
Zurück zum Zitat Gasparini G, Papaleo P, Pola P, Cerciello S, Pola E, Fabbriciani C (2006) Local infusion of norepinephrine reduces blood losses and need of transfusion in total knee arthroplasty. Int Orthop 30(4):253–256PubMedCrossRef Gasparini G, Papaleo P, Pola P, Cerciello S, Pola E, Fabbriciani C (2006) Local infusion of norepinephrine reduces blood losses and need of transfusion in total knee arthroplasty. Int Orthop 30(4):253–256PubMedCrossRef
15.
Zurück zum Zitat Braithwaite BD, Robinson GJ, Burge PD (1993) Haemostasis during carpal tunnel release under local anaesthesia: a controlled comparison of a tourniquet and adrenaline infiltration. J Hand Surg Br 18:184–186PubMedCrossRef Braithwaite BD, Robinson GJ, Burge PD (1993) Haemostasis during carpal tunnel release under local anaesthesia: a controlled comparison of a tourniquet and adrenaline infiltration. J Hand Surg Br 18:184–186PubMedCrossRef
Metadaten
Titel
Reactionary haemorrhage reduction with adrenaline infiltration in proximal tibial osteotomy: a randomized clinical study of safety and efficacy
verfasst von
Alfred O. Ogbemudia
Anire Bafor
Loius West-Osemwengie
Publikationsdatum
01.01.2012
Verlag
Springer-Verlag
Erschienen in
Archives of Orthopaedic and Trauma Surgery / Ausgabe 1/2012
Print ISSN: 0936-8051
Elektronische ISSN: 1434-3916
DOI
https://doi.org/10.1007/s00402-011-1389-z

Weitere Artikel der Ausgabe 1/2012

Archives of Orthopaedic and Trauma Surgery 1/2012 Zur Ausgabe

Arthropedia

Grundlagenwissen der Arthroskopie und Gelenkchirurgie. Erweitert durch Fallbeispiele, Videos und Abbildungen. 
» Jetzt entdecken

Update Orthopädie und Unfallchirurgie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.