Comment on Li et al.: Drainage relieves pain without increasing post-operative blood loss in high tibial osteotomy: a pr
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LETTER TO THE EDITOR
Comment on Li et al.: Drainage relieves pain without increasing post-operative blood loss in high tibial osteotomy: a prospective randomized controlled study Hao Yin 1 Received: 20 March 2020 / Accepted: 26 March 2020 # SICOT aisbl 2020
Dear Editor and Authors, We read with great interest the recent article entitled “Drainage relieves pain without increasing post-operative blood loss in high tibial osteotomy: a prospective randomized controlled study” published online in 14 March 2020 issue of International Orthopaedics by Li et al. [1]. The authors performed a prospective randomized controlled study to evaluate the effect of drainage application during HTO on postoperative blood loss, complication rates, and early functional recovery. They achieved an important conclusion that drainage in HTO does not increase patients’ total blood loss, but it can promote early knee function recovery by reducing postoperative pain, lower leg swelling, and the incidence of incision complications. It is a valuable study. Nevertheless, we have several suggestions and queries that we would like to communicate with the authors: 1. Some pre-operative comorbidities of patients were not clear. For example, in the inclusion criteria and exclusion criteria of this paper, we did not know whether any patients had pre-operative lower limb venous dysfunction or venous thrombosis and how they were distributed in the two groups. As far as we know, most patients with osteoarthritis are caused by age, labour, and excessive weight. Such patients may have venous dysfunction of the lower limbs or venous thrombosis due to excessive labour or prolonged standing, which will affect the results of this study, such as post-operative vas score and calf circumference. 2. The type of anaesthesia used during the operation was not specified. Was it general anaesthesia or epidural * Hao Yin [email protected] 1
The Third Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
anaesthesia? We know that different types of anaesthesia have different effects on post-operative pain and vas score [2]. As pain is a bad experience for patients, postoperative multi-mode analgesia was widely used, but the authors did not mention whether patients have been adopted self-controlled analgesia after operation. 3. It was not clear whether the post-operative postures of the two groups were the same. The authors said in group A that a unified drainage tube was placed on the medial side of the osteotomy, emerging from the proximal incision, which was conducive to full drainage when the limb was raised after operation. But they did not clarify whether the control group placed the lower limbs in the same position. We sincerely hope the authors can pay more attention to the details. 4. As the authors note, tranexamic acid and gelatin sponge are widely used in surgery, and post-operative drainage is not absolutely necessary. A retrospective study of 12,992 patients also indicated that drain use was associated with a higher transfusion rate and a
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