EFFECT OF ADRENALINE WASH ON BLOOD LOSS AND TRANSFUSION REQUIREMENTS IN TOTAL HIP ARTHROPLASTY

Abstract

Introduction: Studies have shown that the addition of adrenaline to the saline wash used in total knee replacements reduces blood losses. Our aim was to see if this held true for patients undergoing Total Hip Replacement (THR).

Materials and Methods: Between January 2007 and March 2008 we retrospectively looked at all total hip replacements performed by the senior author. The same standard peri-operative regimen was used throughout. All patients received Aspirin 150mg post operatively for six weeks as thrombo-embolic prophylaxis (unless specifically contra-indicated). All patients had a Bellovac A.B.T (Astra Tech) drain placed deep to the fascia lata at the end of each operation. Blood drained in the first 6 hours was re-infused. After six hours the drain continued to function as a ‘normal drain’. All drains were removed within 24 hours following surgery. Patients were assigned to two groups: one control group of 80 patients, in which a saline solution was used to wash the surgical field, and a second group of 59 patients, in which a saline solution containing a low dose of adrenaline (4mg of 1:1000 in a litre) was used to wash the surgical field.Haemoglobin was determined preoperatively and on the first postoperative day. The total blood loss was calculated. We also measured the decrease in haemoglobin for each patient. Statistical analysis was carried out using the SPSS statistical package.

Results: A total of 139 patients were reviewed. The patient characteristics in both groups were closely matched. No significant differences found in the drop in haemoglobin between both groups P = −0.426. The mean volume of blood lost intraoperatively was also similar. Study 299ml and Control 313ml respectively.

Discussion: Our study suggests that the use of adrenaline wash in patients undergoing THR is of minimal benefit in reducing blood losses. As there is no tourniquet used in THR perhaps this may be explained by the fact that as the circulation is not temporarily disrupted then the local effect of the adrenaline may be lost as it is being washed away at the time of application and local levels do not become sufficiently high to have the desired vaso-constrictor effect.