1. Tourniquetless Total Knee Arthroplasty With Modern Perioperative Protocols Decreases Pain and Opioid Consumption in Women
- Author
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Mark Hood, Julian E. Dilley, Mary Ziemba-Davis, Michael M. Kheir, and R. Michael Meneghini
- Subjects
Adult ,Male ,musculoskeletal diseases ,Opioid consumption ,Blood Loss, Surgical ,Total knee arthroplasty ,03 medical and health sciences ,0302 clinical medicine ,Blood loss ,Humans ,Medicine ,Orthopedics and Sports Medicine ,030212 general & internal medicine ,Arthroplasty, Replacement, Knee ,Aged ,Retrospective Studies ,Aged, 80 and over ,Pain, Postoperative ,030222 orthopedics ,Tourniquet ,business.industry ,Bone Cements ,Retrospective cohort study ,Perioperative ,Middle Aged ,Tourniquets ,musculoskeletal system ,equipment and supplies ,Analgesics, Opioid ,Hospitalization ,body regions ,surgical procedures, operative ,Anesthesia ,Female ,business - Abstract
This study examined whether a modern total knee arthroplasty (TKA) protocol without a tourniquet results in less patient-reported pain and in-hospital opioid consumption compared to TKA with a tourniquet.A retrospective study of 203 primary unilateral cemented TKAs consecutively performed with or without tourniquet was performed. Identical perioperative pain and blood loss protocols were used in all cases. In tourniquetless TKAs, the tourniquet was not inflated at any time, and sterile COAfter exclusions for scientific confounds, 184 TKAs (93 with tourniquet; 91 tourniquetless) were analyzed. Controlling for multiple covariates, females with a tourniquet reported significantly more pain (P = .002) and opioid consumption (P.001) the first 24 hours after surgery compared to females without a tourniquet. There were no differences in pain (P = .192) or amount of opioids consumed (P = .203) among males with and without a tourniquet. Tourniquet use resulted in a significant reduction in blood loss for both females (P ≤ .040) and males (P ≤ .020), although the total blood savings of approximately 200 mL is of unknown clinical significance.Avoiding tourniquet use during TKA for females may be a relatively risk-free adjunct to minimize opioid consumption during hospitalization. Further study is warranted to elucidate the factors accounting for different outcomes in females and males.
- Published
- 2018