Influence of the Intraoperative Tourniquet Application Method on the Perioperative Blood Loss, Frequency of Transfusion and Close Postoperative Outcomes in Primary Total Knee Arthroplasty Patients
Overview
- Phase
- Not Applicable
- Intervention
- Not specified
- Conditions
- Knee Osteoarthritis
- Sponsor
- Vilnius University
- Enrollment
- 120
- Locations
- 1
- Primary Endpoint
- Perioperative blood loss.
- Status
- Completed
- Last Updated
- 12 years ago
Overview
Brief Summary
Different strategies of tourniquet application during elective primary total knee arthroplasty are thought to be associated with different outcomes. In that context, the study investigates different tactics in the search of optimal application of the tourniquet and the related fluid management during 24 perioperative hours.
Detailed Description
The optimal application of tourniquet should reduce perioperative blood loss, create bloodless operative field, improve cementing technique and shorten surgery time. Meanwhile, inadequate application may increase the risk of deep vein thrombosis and pulmonary thromboembolism. Previous attempts to compare the tourniquet strategies in respect to the perioperative blood loss did not show significant difference. The investigators use the volume loading test aiming to optimize the fluid status and obtain the hemoglobin concentration in the conditions of standardized plasma dilution. The test is deployed just before the surgery and after postoperative 24 hrs in ICU. Functional outcomes and possible length of hospital stay is also evaluated.
Investigators
Narunas Porvaneckas
Pofessor, PhD
Vilnius University
Eligibility Criteria
Inclusion Criteria
- •Patients with osteoarthritis of the knee undergoing total knee arthroplasty with spinal-epidural anesthesia
- •Age \> 50 and \< 80 years
- •ASA (American Society of Anesthesiology Classification) II physical status
- •Signed informed consent form
Exclusion Criteria
- •History of a bleeding disorder
- •Current chronic anticoagulation therapy
- •History of DVT (Deep Vein Thrombosis), thromboembolic complications, acute cardiac insufficiency
- •Anemia before surgery required blood transfusion
- •ASA I, ASA\>=III physical status
- •Age \< 50 and \> 80 years
- •BMI (Body Mass Index) \< 20 and \> 40kg/m2
- •Intravascular fluid infusion within 24 hours before study
- •Chronic non-steroidal anti-inflammatory drug use (more than 6month daily use)
- •Rheumatoid arthritis
Outcomes
Primary Outcomes
Perioperative blood loss.
Time Frame: Before (baseline) the surgery and 24 hrs postoperatively
The volume loading test is deployed for the comparison of perioperative hemoglobin in the standardized plasma dilution.
Secondary Outcomes
- Wound healing(Within 6 days postoperatively)
- Hemodilution(Within 6 days postoperatively)
- Cardiac stroke volume(Within 6 days postoperatively)
- Body temperature(Within 6 days postoperatively)
- Pain (Visual Analog Scale)(Within 6 days postoperatively)
- Number of opiate injections(Within 6 days postoperatively)
- Straight-leg raising test(Within 6 days postoperatively)
- Timed up and go test(Within 6 days postoperatively)
- Knee flexion, extension, extension lag(Within 6 days postoperatively)
- Knee swelling(Within 6 days postoperatively)
- Complications(Within 6 days postoperatively)