RECOVERY OF HEMOGLOBIN LEVEL FOLLOWING TOTAL KNEE ARTHROPLASTY WITH PERIARTICULAR EPINEPHRINE INJECTION

Abstract

Background:  Anemia is one of the common complications occurring after total knee arthroplasty (TKA). A periarticular epinephrine injection could reduce intraoperative blood loss after TKA. However, the duration of hemoglobin recovery to preoperative level remains uncertain. The hypothesis was based on the concept that epinephrine affects vasoconstriction and reduces blood loss. This study was conducted to compare the duration of hemoglobin recovery to preoperative level between periarticular epinephrine injection and periarticular nonepinephrine injection groups and postoperative blood transfusion. Methods: A total of 141 participants were randomized to receive a periarticular epinephrine and bupivacaine injection (epinephrine group) or periarticular bupivacaine injection (non-epinephrine group) among patients undergoing TKA. The solution consisted of 10 g of epinephrine 1 ml and 20 ml of 0.25% bupivacaine. In another group, the solution consisted of 20 ml of 0.25% bupivacaine alone.  All TKAs were managed under spinal anesthesia using a femoral nerve block. Preoperative and postoperative hemoglobin (Hb) and hematocrit (Hct) levels were assessed 1-day, 3-day and monthly until 6 months. Blood loss and the duration of Hb recovery to preoperative level were compared between the two groups. Results: The percentage of Hb loss was slightly higher in the epinephrine group than that in the nonepinephrine group but without significance (13.4 ± 6.6% vs. 13.01 ± 5.01%; p=0.703). The duration of Hb recovery to preoperative level was about the same in the epinephrine and nonepinephrine groups (2.52 ± 1.080 months vs. 2.56 ± 1.089 months; p=0.855). The calculated total blood loss in the epinephrine group was lower than that in the nonepinephrine group (570 ± 302 mL vs. 573 ± 228 mL; p=0.955). In this study, surgery was performed without blood transfusions. Conclusion: The duration of Hb recovery to preoperative level was 2.5 months which was about the same in both groups. Epinephrine injection did not decrease total blood volume loss after TKA under spinal anesthesia.