The Role of Drains and Tourniquets in Primary Total Knee Replacement – A Comparative Study of TKR Performed With Drains and Tourniquet Versus No Drains and Adrenaline and Saline Infiltration

ABSTRACT

One hundred fifteen consecutive patients undergoing TKR were divided into two groups to determine whether blood loss and transfusion in total knee replacement (TKR) using adrenaline with saline infiltration would be less than TKR with tourniquet and drain.

Group 1, composed of 60 patients, received 2.5 mg of 1:1000 adrenaline diluted in 500 mL of normal saline, which was infiltrated into the skin, subcutaneous tissues, and capsule before surgical incision. No tourniquets or postoperative drains were used. Group 2, composed of 55 patients, had a tourniquet and postoperative drain. Thromboprophylaxis with low molecular weight heparin also was used.

Pre- and postoperative hemoglobin, blood loss, hematocrit, and transfusion requirements were studied in both groups; in group 2, blood loss in the drains also was noted. Average preoperative hemoglobin and hematocrit in the two groups were 13.7 g/dL and 39.3 g/dL, respectively, and 13.5% and 39%, respectively. Average intraoperative blood loss was 290 mL in group 1 and 377.7 mL in group 2 (P < .005). Postoperative blood loss in group 1 was <50 mL based on dressing soakage and 297.7 mL in group 2 (P < .005).

Average postoperative hemoglobin and hematocrit in the two groups were 10.6 g/dL and 8.4 g/dL, respectively, and 35.4% and 31.1%, respectively. Transfusion rates were 3.3% and 23.6%, respectively (P < .005). The average volume transfused was 1.2 U.

Adrenaline and saline infiltration is safe and helps reduce intraoperative blood loss. Suction drain use for surgical wounds after primary, uncomplicated TKR is questionable.