Intraoperative Risk Factors

Intraoperative Blood Management Techniques

Techniques to control intra-operative and postoperative bleeding for various orthopedic procedures including: Cell savage, antifibrinolytic agents (TXA), anesthetic techniques, patient positioning, surgical techniques, and local agents.

Some procedures recognized with increased risk for blood loss include:

  • Spine deformity correction
  • Pelvic osteotomies
  • Revision procedures of the hip and knee

Surgeon Tools/Recommendations:

Preoperative Considerations:

  • Important that management of potential blood loss begins before the patient enters the operating room
  • Awareness of medication and supplements patient is taking at home that can increase risk of bleeding:
    • Blood thinners: Aspirin, Plavix, warfarin, Xarelto, lovenox
    • NSAIDs: Ibuprofen, naproxen, meloxicam, Celebrex
    • Supplements: Garlic, ginkgo, ginseng, fish oil, flax seed oil, and saw palmetto

8-Step Checklist for Pre-, Intra-, Post-operative Reduction of Blood Loss in Total Knee and Total Hip Replacement

  1. Normalize preoperative hemoglobin
  2. Discontinue NSAIDs and anticoagulants before surgery
  3. Injection of IV TXA (10mg/kg) 30 minutes preoperatively and 4 hours postoperatively
  4. Local injection of ropivacaine, adrenaline and ketorolac before incision
  5. Careful hemostasis - dry wound
  6. Bone wax after femoral neck osteotomy (THA)
  7. Avoid hypertension throughout the anesthesia
  8. Efficient surgery with shortened operative times