Abstract: BACKGROUND: Total knee arthroplasty can produce a lot of blood loss and severe pain. How to effectively reduce blood loss and pain after total knee arthroplasty has become an urgent problem for joint surgeons.
OBJECTIVE: To observe the effects of intravenous tranexamic acid combined with periarticular multipoint injection of tranexamic acid cocktail on blood loss and pain after total knee arthroplasty.
METHODS: Totally 90 patients who underwent primary unilateral total knee arthroplasty admitted to the Department of Orthopedics of the First Affiliated Hospital of Zhengzhou University from June 2018 to May 2019 were selected and randomly divided into three groups (n=30) according to the envelope method. Patients in the group A were intravenously injected with tranexamic acid (1 g:100 mL) combined with periarticular multipoint infiltration injection of 50 mL normal saline before the implantation of prosthesis. Patients in the group B were intravenously injected with tranexamic acid (1 g:100 mL) combined with periarticular multipoint infiltration injection of 50 mL cocktail (0.3 mL epinaphrine, 10 mL ropivacaine, 0.5 mL morphine, 39.2 mL normal saline) before the implantation. Patients in the group C were intravenously injected with tranexamic acid (1 g:100 mL) combined with periarticular multipoint infiltration injection of cocktail complex tranexamic acid (1 g:10 mL), a total of 50 mL, before the implantation. Total blood loss, drainage volume, hidden blood loss, maximum hemoglobin decline, transfusion rate and transfusion volume, visual analogue scale at rest and activity at 1, 3, 7, and 14 days after surgery, and incidence of deep vein thrombosis and other adverse events were compared among the three groups.
RESULTS AND CONCLUSION: (1) In terms of blood loss, total blood loss, recessive blood loss, drainage volume and postoperative maximum hemoglobin decline in group C were all lower than those in the other two groups, with statistically significant differences (P < 0.05). It was worth mentioning that the drainage volume of group B was lower than that of group A, with statistically significant difference (P < 0.05). (2) For postoperative analgesia, visual analogue scale scores of group B and group C at rest on day 1, 3 and 7 were significantly lower than those of group A (P < 0.05), and the difference between group B and group C was not statistically significant (P > 0.05). Visual analogue scale scores at rest at 14 days after surgery showed no statistically significant difference among the three groups (P=0.898). During the activity, visual analogue scale scores of group B and group C at 1 and 3 days after surgery were significantly lower than group A (P < 0.05), but there was no statistically significant difference between group B and group C (P > 0.05). There was no statistically significant difference in visual analogue scale scores of the three groups at 7 and 14 days after surgery (P > 0.05). (3) There was no significant difference in blood transfusion rate and volume among the three groups (P > 0.05). (4) No deep vein thrombosis or other adverse events occurred in the three groups. (5) The results show that intraoperative intravenous tranexamic acid combined with periarticular multipoint infiltration injection of tranexamic acid cocktail can effectively reduce the blood loss, with effective early analgesia, and the analgesia effect is better when the patient is resting after the operation. There is no increased risk of deep vein thrombosis and other adverse events when the proposed therapy is applied to the patients. 

Key words: total knee arthroplasty, tranexamic acid, cocktail, intravenous, local injection, blood loss, visual analogue scale score