The Journal of arthroplasty
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Randomized Controlled Trial Comparative Study
Periarticular Injection After Total Knee Arthroplasty Using Liposomal Bupivacaine vs a Modified Ranawat Suspension: A Prospective, Randomized Study.
The purpose of this study is to compare liposomal bupivacaine to a modified (Ranawat) local injection for total knee arthroplasty (TKA). ⋯ Liposomal bupivacaine as a periarticular injection after TKA demonstrated similar pain levels, narcotic usage, and range of motion compared to a modified Ranawat suspension but improved walking distance.
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Randomized Controlled Trial
Combined Administration of Systemic and Topical Tranexamic Acid for Total Knee Arthroplasty: Can It Be a Better Regimen and Yet Safe? A Randomized Controlled Trial.
Total knee arthroplasty (TKA) is associated with substantial blood loss in postoperative period. Tranexamic acid (TXA) is potent antifibrinolytic agent, routinely administered by intravenous (IV) and topical route, which can possibly interrupt cascade of events due to hemostatic irregularities close to source of bleeding. However, scientific evidence of combined administration of TXA in TKA is still meagre. The present study aimed to compare efficacy of combined IV and topical TXA with IV use alone in terms of blood loss, transfusion rate, and incidence of deep vein thrombosis and thromboembolism. ⋯ Combined use of IV and intraarticular TXA provided significantly better results compared with IV use alone with respect to all variables related to postoperative blood loss in TKA. Moreover, TXA use is safe in terms of incidence of symptomatic DVT and TE.
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Randomized Controlled Trial
Topical Application of Tranexamic Acid Plus Diluted Epinephrine Reduces Postoperative Hidden Blood Loss in Total Hip Arthroplasty.
We evaluated the efficacy and safety of topical application of tranexamic acid (TXA) plus diluted epinephrine (DEP) and its effect on perioperative hidden blood loss and transfusion requirement in primary unilateral total hip arthroplasty (THA). We randomized 107 patients undergoing THA into two groups: 53 received intra-articular TXA 3 g plus 1:200,000 DEP 0.25 mg; 54 received topical TXA 3 g alone. Results showed that combined administration significantly reduced total blood loss (P=0.009), hidden blood loss (P=0.001) and transfusion rate (1.9 vs. 9.3%) compared with TXA alone, without increasing the risks of thromboembolic and hemodynamic complications. Topical TXA plus DEP in THA can decrease postoperative hidden blood loss and avoid homologous transfusion without substantial complications.
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Randomized Controlled Trial
Impact of Melatonin on Sleep and Pain After Total Knee Arthroplasty Under Regional Anesthesia With Sedation: A Double-Blind, Randomized, Placebo-Controlled Pilot Study.
This pilot study explores sleep disruption after total knee arthroplasty and the impact of melatonin on sleep and postoperative pain. Sleep time was decreased on the last preoperative night and first two postoperative nights. ⋯ Melatonin appeared to have no effect on subjective sleep quality or daytime sleepiness, pain at rest or pain with standardized activity. In conclusion, sleep quality is impaired after total knee arthroplasty and exogenous melatonin does not appear to improve postoperative sleep or pain to a significant degree.
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Randomized Controlled Trial
Sleep Quality Effects Recovery After Total Knee Arthroplasty (TKA) - A Randomized, Double-Blind, Controlled Study.
This study examined the effects of sleep quality on early recovery after total knee arthroplasty. A total of 148 patients were randomized 1:1 to receive either zolpidem or placebo for 2 weeks. VAS pain scores (rest, ambulation and night), range of motion (ROM), total amount of opioid analgesics and antiemetics taken, postoperative nausea and vomiting (PONV), sleep efficacy and satisfaction were recorded. ⋯ Patients in the intervention group had lower pain score and took less antiemetics. Moreover, a significant correlation between sleep quality and ROM was detected. These results demonstrated that improved sleep quality is beneficial to patients' post-TKA recovery.