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Tourniquet Use Improves Intra-Operative Parameters Leading to Similar Post-Operative Outcomes Compared No Tourniquet Use in Anterior Cruciate Ligament Reconstruction: A Prospective, Double-Blind, Randomized Clinical Trial
Zaid HHG, Hua X, Chen B, Yang Q, Yang G, Chenwei N
Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association. 2022
Abstract
PURPOSE To examine the effect of tourniquet use in arthroscopic ACL reconstruction in terms of: (1) intraoperative visualization with operative time and consumption of sterile saline, and (2) intra- and postoperative blood loss, postoperative pain, opioid consumption, swelling, serum creatine phosphokinase (CPK) hemoglobin concentration (Hb), clinical outcomes, and graft healing. METHODS In this prospective randomized clinical trial, patients were assigned to tourniquet inflation (tourniquet-up) or tourniquet deflation (tourniquet-down) groups. Primary outcomes were intraoperative visualization with operative time and sterile saline consumption. Secondary outcomes were intra- and postoperative blood loss, postoperative pain, opioid consumption, swelling, serum creatine phosphokinase (CPK) ,hemoglobin concentration (Hb), subjective and objective functional scores, and graft healing. RESULTS Intraoperative visualization was satisfactory in 100 of 100 cases in the tourniquet-up group and 64 of 100 cases in the tourniquet-down group (P < .05). The mean operative time was 58.4 ± 5.7 min in the tourniquet-up group and 72.5 ± 8.6 min in the tourniquet-down group (P < .05). The mean sterile saline consumption was 6.4 ± 2.5 L in the tourniquet-up group, and 8.7 ± 4.6 L in the tourniquet-down group (P < .05). The respective amounts of estimated intraoperative and postoperative blood loss were 95.3 ± 25.1 and 240.3 ± 44.5 mL in the tourniquet-up group and 230.2 ± 22.3 and 75.6 ± 15.3 mL in the tourniquet-down group (P < .05). Our results showed no significant difference in postoperative pain, opioid consumption, percentage of patients using opioids, swelling, mean serum CPK level, Hb level, subjective and objective functional scores, or graft healing (P > .05) between the two groups. CONCLUSIONS Tourniquet utilization during ACL reconstruction significantly improves intraoperative visualization, shortens operative time, and decreases intraoperative sterile saline consumption and blood loss without serious adverse events or higher complication rates based on early postoperative outcomes.
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2.
Effect of Oral Tranexamic Acid on the Blood Transfusion Rate and the Incidence of Deep Vein Thromboembolism in Patients after TKA
Chen B, Qu X, Fang X, Wang X, Ke G
Evidence-based complementary and alternative medicine : eCAM. 2022;2022:6041827
Abstract
PURPOSE To explore the effect of oral tranexamic acid treatment on the blood transfusion rate and the incidence of deep vein thromboembolism after total knee arthroplasty (TKA). METHODS 90 patients undergoing TKA admitted to First People's Hospital of Changshu City from January 2019 to January 2020 were selected and randomized into the control group and the experimental group accordingly (45 cases in each group). The control group intravenously received 20 mL/kg tranexamic acid before the incision was closed. The experimental group was given 1 g of tranexamic acid orally before anesthesia, 6 h and 12 h after the operation. RESULTS The experimental group witnessed better perioperative indexes in relation to the control group. The experimental group displayed better postoperative coagulation function indexes as compared to the control group (P < 0.05). Remarkably lower postoperative vascular endothelial function indexes in the experimental group than in the control group were observed. The experimental group experienced a markedly lower incidence of deep vein thromboembolism in comparison with the control group (P < 0.05). The postoperative knee society score (KSS) score of the experimental group was significantly higher than that of the control group. A significantly higher postoperative modified rivermead mobility index (MRMI) score was yielded in the experimental group in contrast to the control group (P < 0.05). The experimental group obtained lower numerical rating scale (NRS) scores at T2 and T3 as compared to the control group. CONCLUSION Oral tranexamic acid is a suitable alternative for patients undergoing TKA in terms of reducing the blood transfusion rate, relieving pain, and accelerating the recovery of the patient's limbs.
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3.
Predictive performance of dynamic arterial elastance for arterial pressure response to fluid expansion in mechanically ventilated hypotensive adults: a systematic review and meta-analysis of observational studies
Zhou X, Pan W, Chen B, Xu Z, Pan J
Annals of intensive care. 2021;11(1):119
Abstract
BACKGROUND Dynamic arterial elastance (Ea(dyn)) has been extensively considered as a functional parameter of arterial load. However, conflicting evidence has been obtained on the ability of Ea(dyn) to predict mean arterial pressure (MAP) changes after fluid expansion. This meta-analysis sought to assess the predictive performance of Ea(dyn) for the MAP response to fluid expansion in mechanically ventilated hypotensive patients. METHODS We systematically searched electronic databases through November 28, 2020, to retrieve studies that evaluated the association between Ea(dyn) and fluid expansion-induced MAP increases in mechanically ventilated hypotensive adults. Given the diverse threshold value of Ea(dyn) among the studies, we only reported the area under the hierarchical summary receiver operating characteristic curve (AUHSROC) as the primary measure of diagnostic accuracy. RESULTS Eight observational studies that included 323 patients with 361 fluid expansions met the eligibility criteria. The results showed that Ea(dyn) was a good predictor of MAP increases in response to fluid expansion, with an AUHSROC of 0.92 [95% confidence interval (CI) 0.89 to 0.94]. Six studies reported the cut-off value of Ea(dyn), which ranged from 0.65 to 0.89. The cut-off value of Ea(dyn) was nearly conically symmetrical, most data were centred between 0.7 and 0.8, and the mean and median values were 0.77 and 0.75, respectively. The subgroup analyses indicated that the AUHSROC was slightly higher in the intensive care unit (ICU) patients (0.96; 95% CI 0.94 to 0.98) but lower in the surgical patients in the operating room (0.72; 95% CI 0.67 to 0.75). The results indicated that the fluid type and measurement technique might not affect the diagnostic accuracy of Ea(dyn). Moreover, the AUHSROC for the sensitivity analysis of prospective studies was comparable to that in the primary analysis. CONCLUSIONS Ea(dyn) exhibits good performance for predicting MAP increases in response to fluid expansion in mechanically ventilated hypotensive adults, especially in the ICU setting.
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Prophylactic clips to reduce delayed polypectomy bleeding after resection of large colorectal polyps: a systematic review and meta-analysis of randomized trials
Chen B, Du L, Luo L, Cen M, Kim JJ
Gastrointestinal endoscopy. 2020
Abstract
BACKGROUND AND AIMS Prophylactic clips to prevent delayed polypectomy bleeding (DPB) after endoscopic resection of large colorectal polyps remains controversial. We performed a systematic review and meta-analysis to evaluate the efficacy of prophylactic clips for preventing DPB by synthesizing the results of randomized trials. METHODS PubMed, Cochrane Library, and EMBASE through October 2019 were searched to identify randomized controlled trials evaluating the efficacy of placing prophylactic clips to reduce DPB after resection of large (>10 mm) colorectal polyps. The primary outcome was DPB defined by GI bleeding after the conclusion of the colonoscopy. RESULTS Eight studies (N=3,415) met the study criteria, all with a low risk of bias. The overall pooled incidence of DPB was 3.9% (95% CI, 2.4%-5.4%) in patients receiving endoscopic resection of colorectal polyps >10 mm. Placing prophylactic clips reduced DPB in patients receiving prophylactic clips (RR, 0.61; 95% CI, 0.43-0.85; I(2)=37.8%) compared with no clips with a number-needed-to treat (NNT) of 52 (95% CI, 31-163). In stratified analyses, placing clips was associated with reduced risks of DPB in patients with polyp >20 mm (RR, 0.54; 95% CI, 0.35-0.84; I(2)=0.0%; NNT, 30), non-pedunculated morphology (RR, 0.54; 95% CI, 0.36-0.81; I(2)=0.0%; NNT, 39), and located proximal to the hepatic flexure (RR, 0.49; 95% CI, 0.31-0.78; I(2)=54.8%; NNT, 25) compared with no clips. CONCLUSIONS Prophylactic clips after endoscopic resection of colorectal polyps >10 mm demonstrated a modest reduction in the risk of DPB. Larger reductions were observed in patients with polyps >20 mm, nonpedunculated morphology, or located proximal to the hepatic flexure.
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5.
Different techniques of minimally invasive craniopuncture for the treatment of hypertensive intracerebral hemorrhage
Xia L, Han Q, Ni XY, Chen B, Yang X, Chen Q, Cheng GL, Liu CF
World neurosurgery. 2019
Abstract
OBJECTIVE Efficacy of minimally invasive craniopuncture with the YL-1 puncture needle (hard-channel) and soft drainage tube (soft-channel) in treating hypertensive intracerebral hemorrhage (HICH). MATERIALS AND METHODS Totally 150 HICH patients were randomly assigned into three groups, conservative group (n=50), hard-channel group (n=50) and soft-channel group (n=50). Computed tomography, National Institutes of Health Stroke Scale (NIHSS) and levels of interleukin-6 (IL-6), tumor necrosis factor-alpha (TNF-alpha), superoxide dismutase (SOD) and malondialdehyde (MDA) in serum and in drainage fluid were examined on day2, 4, 6 post operation. RESULTS Compared with conservative group, serum levels of IL-6, TNF-alpha and MDA were decreased and SOD was increased (p<0.05); volumes of hematoma and peri-hematomal edema as well as NIHSS were reduced (p<0.05) in minimally invasive groups on day7, 14, 28 post operation. Compared with the hard-channel group, serum levels of IL-6, TNF-alpha, MDA and SOD appeared the same trend as above in the soft-channel group. In the soft-channel group, MDA was reduced and SOD was increased in brain drainage fluid on day2, 4, 6 (p<0.05); volumes of hematoma and peri-hematomal edema on day14, 28 appeared reduction compared with the hard-channel group (p<0.05). There was no significant difference of volumes of hematoma and peri-hematomal edema on day7 between minimally invasive groups. NIHSS of the soft-channel group appeared a significant reduction on day7, 14, 28 post operation (p<0.05). CONCLUSION Soft-channel minimally invasive craniopuncture is an ideal technique for treating HICH, with advantages of alleviating cerebral edema, reducing oxidative stress and inhibiting inflammatory response.
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6.
Topical tranexamic acid reduces blood loss in minimally invasive total knee arthroplasty receiving rivaroxaban
Yen S H, Lin P C, Chen B, Huang C C, Wang J W
Biomed Research International. 2017;2017:9105645.
Abstract
Background: It is unclear whether topical (intra-articular) or intravenous TXA reduces blood loss in minimally invasive TKA patients receiving a direct oral anticoagulant for thromboprophylaxis. This study is to investigate whether TXA given intravenously or intra-articularly is effective in reducing blood loss in minimally invasive TKA patients using rivaroxaban for thromboprophylaxis. Methods: Ninety-three patients who underwent primary minimally invasive TKA were divided into placebo group (30 patients) that received saline both intravenously and intra-articularly, intravenous (IV) group (31 patients) that received 1 g TXA intravenously, and topical group (32 patients) that received 3 g TXA in 100 ml saline intra-articularly. All patients received oral rivaroxaban of 10 mg daily for 14 days postoperatively. Results: p < 0.001 and p = 0.041. The mean total blood loss was 1131 mL (567-1845) in placebo, which was higher than that in the IV group (921 mL; range, 465-1495; p = 0.014) and the topical group (795 mL; range, 336-1350; p < 0.001). The total blood loss did not differ between the IV and the topical group (p = 0.179). Conclusion: This prospective, randomized, controlled trial demonstrated an equal efficacy of TXA in blood conservation when administered intravenously or topically in minimally invasive TKA patients receiving rivaroxaban for thromboprophylaxis.
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7.
The efficacy of combined use of rivaroxaban and tranexamic acid on blood conservation in minimally invasive total knee arthroplasty a double-blind randomized, controlled trial
Wang JW, Chen B, Lin PC, Yen SH, Huang CC, Kuo FC
The Journal of Arthroplasty. 2016;32((3):):801-806
Abstract
BACKGROUND Tranexamic acid (TXA) was reportedly to decrease postoperative blood loss after standard total knee arthroplasty (TKA). However, the blood-conservation effect of TXA in minimally invasive TKA, in particular, receiving a direct oral anticoagulant was unclear. The aim of the study was to investigate the efficacy of combined use of TXA and rivaroxaban on postoperative blood loss in primary minimally invasive TKA. METHODS In a prospective, randomized, controlled trial, 198 patients were assigned to placebo (98 patients, normal saline injection) and study group (100 patients, 1g TXA intraoperative injection) during primary unilateral minimally invasive TKA. All patients received rivaroxaban 10 mg each day for 14 doses postoperatively. Total blood loss was calculated from the maximum hemoglobin drop after surgery plus amount of transfusion. The transfusion rate and wound complications were recorded in all patients. Deep-vein thrombosis was detected by ascending venography of the leg 15 days postoperatively. RESULTS The mean total blood loss was lower in the study group (1020 mL [95% confidence interval, 960-1080 mL]) compared with placebo (1202 mL [95% confidence interval, 1137-1268 mL]) (P < .001). The transfusion rate was lower in the study group compared with placebo (1% vs 8.2%, P = .018). Postoperative wound hematoma and ecchymosis were higher in placebo than the study group (P = .003). There was no symptomatic deep-vein thrombosis or pulmonary embolism in either group. CONCLUSION Systemic administration of TXA can effectively reduce the postoperative blood loss which results in lower rate of transfusion requirement and wound hematoma in minimally invasive TKA patients when rivaroxaban is used for thromboprophylaxis. Rivaroxaban has a high rate of bleeding complications when used alone in TKA patients.