Epinephrine-augmented hypotensive epidural anesthesia replaces tourniquet use in total knee replacement

Clin Orthop Relat Res. 2005 Jul;(436):184-9. doi: 10.1097/01.blo.0000161825.90633.12.


Tourniquets commonly are used during total knee arthroplasties to reduce intraoperative blood loss, despite their various side effects. The goal of this study was to determine whether tourniquet use could be avoided using epinephrine-augmented hypotensive epidural anesthesia during a total knee arthroplasty without negative effects on perioperative hemoglobin values. One hundred patients having total knee arthroplasties were included in a prospective, observer-blinded, controlled, and randomized study. Forty-nine patients received epinephrine-augmented hypotensive epidural anesthesia without use of a tourniquet (Group A), and 51 patients received normotensive epidural anesthesia with use of a tourniquet (Group B). Hemoglobin was evaluated and is reported preoperatively, immediately and 6 hours postoperatively, and on Days 1, 2, 3, 5, and 6 in absolute and relative values. Data were not collected for Day 4. Greater absolute and relative postoperative hemoglobin values were observed in Group A immediately postoperative, on Day 5, and on Day 6. In patients who did not have transfusions, the mean relative hemoglobin values were greater in Group A at all times evaluated (except on Day 1). Epinephrine-augmented hypotensive epidural anesthesia is an effective method to avoid the use of a tourniquet during total knee arthroplasty without the negative effects on perioperative hemoglobin values.

Level of evidence: Therapeutic study, Level I-1a (randomized controlled trial, significant difference). See the Guidelines for Authors for a complete description of levels of evidence.

Publication types

  • Clinical Trial
  • Randomized Controlled Trial

MeSH terms

  • Aged
  • Anesthesia, Epidural*
  • Anesthesia, Spinal
  • Arthroplasty, Replacement, Knee / methods*
  • Blood Loss, Surgical / prevention & control*
  • Epinephrine / therapeutic use*
  • Evidence-Based Medicine
  • Female
  • Hemoglobins / analysis
  • Hemostasis, Surgical / methods*
  • Humans
  • Hypotension, Controlled
  • Male
  • Middle Aged
  • Single-Blind Method
  • Tourniquets*
  • Treatment Outcome
  • Vasoconstrictor Agents / therapeutic use*


  • Hemoglobins
  • Vasoconstrictor Agents
  • Epinephrine