Yong-Cheol Lee1, Sang-Jin Park2, Ji-Seob Kim3, Chul-Hyun Cho4. 1. Department of Anesthesiology and Pain Medicine, Keimyung University, School of Medicine, Daegu, 700-712, Korea. Electronic address: yclee@dsmc.or.kr. 2. Department of Anesthesiology and Pain Medicine, College of Medicine, Yeungnam University, Daegu, 705-717, Korea. 3. Department of Anesthesiology and Pain Medicine, Keimyung University, School of Medicine, Daegu, 700-712, Korea. 4. Department of Orthopedic Surgery, Keimyung University, School of Medicine, Daegu, 700-712, Korea.
Abstract
STUDY OBJECTIVE: To determine whether the use of tranexamic acid in the setting of hypotension induced by hypotensive epidural anesthesia (HEA) has any additional beneficial effects in reducing perioperative blood loss and transfusion requirements in total hip replacement. DESIGN: Prospective, randomized, double-blinded trial. SETTING: University-affiliated hospital. PATIENTS: 68 adult, ASA physical status 1 and 2 patients undergoing primary unilateral cementless total hip replacement with general anesthesia and HEA. INTERVENTIONS: The HEATA group received a bolus dose of 15 mg/kg of tranexamic acid before surgical incision, followed by a continuous 15 mg/kg infusion until skin closure. The HEA group received normal saline instead of tranexamic acid in the same manner. MEASUREMENTS: Intraoperative blood loss was measured using the difference between the weights of used gauze and the original unused gauze, in addition to the blood volume accumulated in suction bottles. Postoperative blood loss was considered to be the amount of blood accumulated in drainage bags. MAIN RESULTS: There was no significant difference in intraoperative blood loss between the HEA and HEATA groups (251.8 ± 109.9 mL vs. 234.9 ± 93.9 mL), but postoperative blood loss was significantly less in the HEATA group than the HEA group (439.3 ± 171. 6 mL vs. 1074.4 ± 287.1 mL), as was total cumulative blood loss (674.2 ± 216.4 mL vs. 1326.2 ± 347.8 mL). There was no significant difference in intraoperative transfusion incidences, but postoperative transfusion was greater in the HEA group than the HEATA group. CONCLUSIONS: Administration of tranexamic acid combined with hypotensive epidural anesthesia reduced postoperative and total accumulative blood loss and transfusion requirements more than did hypotensive epidural anesthesia alone.
RCT Entities:
STUDY OBJECTIVE: To determine whether the use of tranexamic acid in the setting of hypotension induced by hypotensive epidural anesthesia (HEA) has any additional beneficial effects in reducing perioperative blood loss and transfusion requirements in total hip replacement. DESIGN: Prospective, randomized, double-blinded trial. SETTING: University-affiliated hospital. PATIENTS: 68 adult, ASA physical status 1 and 2 patients undergoing primary unilateral cementless total hip replacement with general anesthesia and HEA. INTERVENTIONS: The HEATA group received a bolus dose of 15 mg/kg of tranexamic acid before surgical incision, followed by a continuous 15 mg/kg infusion until skin closure. The HEA group received normal saline instead of tranexamic acid in the same manner. MEASUREMENTS: Intraoperative blood loss was measured using the difference between the weights of used gauze and the original unused gauze, in addition to the blood volume accumulated in suction bottles. Postoperative blood loss was considered to be the amount of blood accumulated in drainage bags. MAIN RESULTS: There was no significant difference in intraoperative blood loss between the HEA and HEATA groups (251.8 ± 109.9 mL vs. 234.9 ± 93.9 mL), but postoperative blood loss was significantly less in the HEATA group than the HEA group (439.3 ± 171. 6 mL vs. 1074.4 ± 287.1 mL), as was total cumulative blood loss (674.2 ± 216.4 mL vs. 1326.2 ± 347.8 mL). There was no significant difference in intraoperative transfusion incidences, but postoperative transfusion was greater in the HEA group than the HEATA group. CONCLUSIONS: Administration of tranexamic acid combined with hypotensive epidural anesthesia reduced postoperative and total accumulative blood loss and transfusion requirements more than did hypotensive epidural anesthesia alone.
Authors: Alex K Freeman; Chris J Thorne; C Louie Gaston; Richard Shellard; Tom Neal; Michael C Parry; Robert J Grimer; Lee Jeys Journal: Clin Orthop Relat Res Date: 2016-05-12 Impact factor: 4.176