Biadsi Ahmad, Akselrad Mor Bracha, Segal David, Gur Shanny, Markushevich Michael, Brin Yaron Shraga
Department of Orthopedic Surgery, Meir Medical Center, Kfar-Saba 4428164, Israel.
Clin Pract. 2025 May 20;15(5):96. doi: 10.3390/clinpract15050096.
: To evaluate the effect of preoperative intra-articular injection of bupivacaine and adrenaline (BAD) on blood loss and postoperative hemoglobin levels in primary total knee replacement. : We retrospectively assessed 38 consecutive patients who underwent primary total knee arthroplasty at our institution between 2018 and 2019, as performed by two chief orthopedic surgeons. The study group included 22 patients who received an intra-articular injection of 40 mL solution of BAD 0.25% preoperatively. The control group included 16 patients who did not receive the BAD injection preoperatively. Both groups received an IV tranexamic acid (TXA) 1 g treatment prior to the first incision. The posterior capsule and soft tissues were infiltrated after femoral chamfer cuts with a 60 mL BAD solution in both groups. Blood loss was evaluated in all patients by measuring the volume collected in the suction container before the first irrigation and prior to cementation. Additional assessments included the volume of blood drained during the first 24 h postoperatively, as well as changes in hemoglobin levels (delta hemoglobin) 24 h after surgery and at hospital discharge. : The study and the control groups were similar in age, sex, demographics, and comorbidities. The mean patient age was 71.4 ± 6.5 in the injected group and 70.6 ± 7.5 in the control group. The volume of blood suctioned during surgery was significantly lower in the study group compared to the control group (201 ± 84.3 mL vs. 261.25 ± 83.3 mL; = 0.04). Similarly, the amount of blood drained within the first 24 h postoperatively was also reduced in the study group (204.3 ± 91.1 mL vs. 363.44 ± 131.9 mL; = 0.0001). Ultimately, the decrease in hemoglobin levels from baseline to discharge was less pronounced in the study group compared to the control group (1.7 ± 0.9 g/dL vs. 2.44 ± 1.3 g/dL; = 0.038). Intra-articular injection of 40 mL bupivacaine and 0.25% adrenaline solution before skin incision may reduce intraoperative and postoperative blood loss among patients undergoing total knee arthroplasty.
评估术前关节腔内注射布比卡因和肾上腺素（BAD）对初次全膝关节置换术中失血及术后血红蛋白水平的影响。我们回顾性评估了2018年至2019年间在我院由两位骨科主任医师进行初次全膝关节置换术的38例连续患者。研究组包括22例术前接受关节腔内注射40 mL 0.25% BAD溶液的患者。对照组包括16例术前未接受BAD注射的患者。两组在首次切口前均接受静脉注射氨甲环酸（TXA）1 g治疗。两组在股骨倒角切割后均用60 mL BAD溶液浸润后关节囊和软组织。通过测量首次冲洗前和骨水泥固定前吸引容器中收集的血量来评估所有患者的失血量。额外评估包括术后24小时内引流的血量，以及术后24小时和出院时血红蛋白水平的变化（血红蛋白差值）。研究组和对照组在年龄、性别、人口统计学和合并症方面相似。注射组患者的平均年龄为71.4±6.5岁，对照组为70.6±7.5岁。与对照组相比，研究组术中吸引的血量显著更低（201±84.3 mL对261.25±83.3 mL；P = 0.04）。同样，研究组术后24小时内引流的血量也减少了（204.3±91.1 mL对363.44±131.9 mL；P = 0.0001）。最终，与对照组相比，研究组从基线到出院时血红蛋白水平的下降不那么明显（1.7±0.9 g/dL对2.44±1.3 g/dL；P = 0.038）。皮肤切口前关节腔内注射40 mL布比卡因和0.25%肾上腺素溶液可能减少全膝关节置换术患者的术中和术后失血。
