| Objective: To explore the effect of "Cocktail" perfusion therapy,including ropivacaine 80 mg,tranexamic acid 2g,epinephrine 0.25 mg and 0.9% medical sodium chloride injection 50 ml,on enhanced recovery after surgery of total knee arthroplasty.Methods: We were enrolled in our hospital(Hospital of South China affiliated to University of South China)for the first time in patients with knee osteoarthritis with one knee Total Knee Arthroplasty from September 1st,2017 to September 1st,2018(patient’s hospitalization start date).A total of 70 cases,including 10 males and 60 females,were knee osteoarthritis patients,aged 57-79 years,with an average age of 66.3 years.They were randomly divided into two groups(random number table method).Group A was a cocktail perfusion group.At the end of TKA surgery,the cocktail mixture was injected into the joint cavity through the drainage tube,and the drainage tube was clamped after the injection was completed,The drainage tube clamp was opened 3 hours after the operation;the B group was a blank control group,and no cocktail perfusion was given,but the drainage tube was clamped in the same manner at the end of the operation,and the drainage tube clamp was opened 3 hours after the operation.The following date were comfared operation time,blood loss,recessive blood loss,Hb change value,Hct change value,postoperative drainage volume,VAS score,American Knee Surgery Society score(KSS),The postoperative knee joint mobility,the first postoperative ground time(from the end of the operation),and the incidence of deep vein thrombosis(DVT)one week after surgery.Results: 1、Preoperative general conditions such as gender composition ratio,height,weight,body mass index(BMI)hemoglobin(Hb),hematocrit(Hct),blood volume,knee resting state VAS score,knee There were no significant differences in the VAS score of joint movement,KSS clinical score of knee joint,KSS functional score of knee joint and knee joint activity(P>0.05)..2、Effectiveness results2.1.The perioperative Hb reduction values of group A and group B were 26.47(17.1,37.7)g/L and 31.32(20.6,39.5)g/L,respectively.The reduction of Hb in perioperative period was significantly lower in group A than that in group B(P<0.01).The perioperative Hct reduction values in group A and group B were 4.33(3.1,5.4)% and 4.85(3.1,6.6)%,respectively.The perioperative Hct reduction in group A was lower than that in group B(P<0.05).2.2.The total blood loss in group A and group B was 453.14(351.0,709.5)ml and 574.92(425.0,834.5)ml,respectively.The total blood loss in group A was significantly lower than that in group B(P<0.05).The drainage volume,dominant blood loss and recessive blood loss in group A were also lower than those in group B(P<0.05).2.3.The VAS scores of resting and exercise status in group A were lower than those in group B at 6th,12 th,and 1st day(P<0.05).There was no significant difference in resting and exercise status VAS scores on on 3rd and 7th day(P>0.05).2.4.In group A,the time of first grounding(from the end of surgery)was 2.84(2,5)days,and the time of first grounding in group B was 4.93(3,7)days.The first time in group A was significantly shorter than that in group B(P <0.01).2.5.The knee joint activity in group A was 105.6(125,87)°,and that in group B was 102.7(130,78)°.The difference was not statistically significant(P>0.05).The knee joint activity in group A was 1 and 3 days after operation.The degree of knee joint activity was higher than that of group B on the 1st and 3rd day after operation(P<0.05),and the difference was statistically significant.There was no significant difference in knee joint activity between the two groups(P>0.05)on the 5th and 7th day after operation.2.6.The clinical and functional scores of KSS at the 14 th day in group A were significantly higher than those in group B(P<0.01).2.7.There was no significant difference in the incidence of blood loss,blood transfusion rate and DVT between the two groups(P>0.05).Conclusion:In the cocktail perfusion group(group A),compared with the blank control group(group B)without cocktail perfusion,the following advantages were found,perioperative bleeding and early pain were significantly reduced,it can increase the degree of joint activity in the early perioperative period at the same time,,shorten the time of the first off-site activity(from the end of the operation),and perform functional exercise early to promote ERAS without increasing the risk of complications such as postoperative DVT. |
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