Blood Loss In Spine Surgery Research Articles

Safety and Efficacy of Tranexamic Acid in Spinal Surgery: A Systematic Review and Meta-Analysis.

Tranexamic acid (TXA) has gained popularity in spinal surgery because of its potential to reduce blood loss. However, concerns regarding its safety and efficacy remain. This systematic review and meta-analysis aimed to evaluate the efficacy of TXA in reducing blood loss and its safety profile in spinal surgeries. A comprehensive search was conducted in electronic databases for randomized controlled trials and prospective studies evaluating the use of TXA in spinal surgery. The primary outcomes were intraoperative and total estimated blood loss (EBL), and the secondary outcomes included the incidence and types of complications associated with TXA use. Meta-analyses were performed using random-effects models. Thirteen studies involving 1,213 participants were included in the meta-analysis. The use of TXA was associated with significant reductions in both intraoperative (mean difference: -46.56 mL [-73.85, -19.26], p<0.01]) and total EBL (mean difference: -210.17 mL [-284.93, -135.40], p<0.01) while also decreasing the need for blood transfusions (risk ratio: 0.68 [0.51, 0.90], p<0.01). No significant difference was found in the incidence and types of thrombotic complications when TXA was used in spinal surgery. Subgroup analysis showed consistent results in instrumentation and fusion surgery and different doses of TXA. TXA is effective in reducing intraoperative and overall blood loss in spinal surgery without increasing the risk of complications. These findings support the use of TXA to improve patient outcomes. However, caution should be exercised because of the heterogeneity among the included studies. Further research is needed to confirm these findings and explore potential long-term complications.

Effect of Dexmedetomidine on Intraoperative Hemodynamics and Blood Loss in Patients Undergoing Spine Surgery: A Systematic Review and Meta-Analysis

Objective Dexmedetomidine (Dex) is a highly selective α2 adrenoceptor agonist that reduces blood pressure and heart rate. However, its ability to provide stable hemodynamics and a clinically significant reduction in blood loss in spine surgery is still a matter of debate. This study aimed to investigate the effects of Dex on intraoperative hemodynamics and blood loss in patients undergoing spine surgery.Methods The Web of Science, MEDLINE, EMBASE, and the Cochrane Library were searched up to February 2023 for randomized controlled trials (RCTs) including patients undergoing spine surgeries under general anaesthesia and comparing Dex and saline. A fixed- or random-effect model was used depending on heterogeneity.Results Twenty-one RCTs, including 1388 patients, were identified. Dex added the overall risk of intraoperative hypotension (odds ratio [OR]: 2.11; 95% confidence interval [CI]: 1.24 - 3.58; P=0.006) and bradycardia (OR: 2.48; 95%CI: 1.57 - 3.93; P=0.0001). The use of a loading dose of Dex led to significantly increased risks of intraoperative hypotension (OR: 2.00; 95%CI: 1.06 - 3.79; P=0.03) and bradycardia (OR: 2.28; 95%CI: 1.42 - 3.66; P=0.0007). For patients receiving total intravenous anesthesia, there was an increased risk of hypotension (OR: 2.90; 95%CI: 1.24 - 6.82; P=0.01) and bradycardia (OR: 2.66; 95%CI: 1.53 - 4.61; P=0. 0005). For patients in the inhalation anesthesia group, only an increased risk of bradycardia (OR: 4.95; 95%CI: 1.41 - 17.37; P=0.01) was observed. No significant increase in the risk of hypotension and bradycardia was found in the combined intravenous-inhalation anesthesia group. The incidence of severe hypotension (OR: 2.57; 95%CI: 1.05 - 6.32; P=0.04), but not mild hypotension, was increased. Both mild (OR: 2.55; 95%CI: 1.06 - 6.15; P=0.04) and severe (OR: 2.45; 95%CI: 1.43 - 4.20; P=0.001) bradycardia were associated with a higher risk. The overall analyses did not reveal significant reduction in intraoperative blood loss. However, a significant decrease in blood loss was observed in total inhalation anesthesia subgroup (mean difference [MD]: -82.97; 95%CI: -109.04 - -56.90; P<0.001).Conclusions Dex increases the risks of intraoperative hypotension and bradycardia in major spine surgery. The administration of a loading dose of Dex and the utilization of various anesthesia maintenance methods may potentially impact hemodynamic stability and intraoperative blood loss.

Prediction of hematocrit decline and the impact of peri-operative fluid use in lumbar spinal fusion surgery

PurposePeri-operative blood loss unaccounted for and post-operative hematocrit decline could have a significant impact on the outcome of elective spinal surgery patients. The study assesses the accuracy of predictive models of hematocrit decline and blood loss in spinal surgery and determines the impact of peri-operative fluid administration on hematocrit levels of patients undergoing first-time single level lumbar fusion surgery for degenerative spine disease and the trend thereof in the first 24 h post-operatively.MethodsClinical and biochemical parameters were prospectively collected in patients undergoing single level lumbar spinal surgery. Predictive models were applied to assess their accuracy in intra-operative blood loss and post-operative hematocrit decline.ResultsHigh correlation (0.98 Pearson correlation coefficient) occurred between calculated (predicted) and recorded hematocrit from hours 2 to 6 post-operatively. Predictive accuracy declined thereafter yet remained moderate. Patients received an average intra-operative fluid volume of 545.45 ml per hour (47% of estimated total blood volume). A significant hematocrit decline occurred post-induction (43.47–39.78%, p < 0.001) with total fluid volume received being the significant contributing variable (p < 0.001). Hypertensive patients were the only subgroup to drop below the safe hematocrit threshold of 30%.ConclusionIatrogenic hemodilution can accurately be predicted for the first six hours post-operatively, with high risk patients identifiable. Fluid therapy should be goal directed rather than generic, and good communication between the surgeon and anesthesiologist remains the cornerstone to manage physiological changes secondary to blood loss. Although helpful, predictive formulas are not universally applicable to all phenotypes.

Minimizing Blood Loss in Spine Surgery.

Study Design:Broad narrative review.Objective:To review and summarize the current literature on guidelines, outcomes, techniques and indications surrounding multiple modalities of minimizing blood loss in spine surgery.Methods:A thorough review of peer-reviewed literature was performed on the guidelines, outcomes, techniques, and indications for multiple modalities of minimizing blood loss in spine surgery.Results:There is a large body of literature that provides a consensus on guidelines regarding the appropriate timing of discontinuation of anticoagulation, aspirin, nonsteroidal anti-inflammatory drugs (NSAIDs), and herbal supplements prior to surgery. Additionally, there is a more heterogenous discussion the utility of preoperative autologous blood donation facilitated by erythropoietin and iron supplementation for healthy patients slated for procedures with high anticipated blood loss and for whom allogeneic transfusion is likely. Intraoperative maneuvers available to minimize blood loss include positioning and maintaining normothermia. Tranexamic acid (TXA), bipolar sealer electrocautery, and topical hemostatic agents, and hypotensive anesthesia (mean arterial pressure (MAP) <65 mm Hg) should be strongly considered in cases with larger exposures and higher anticipated blood loss. There is strong level 1 evidence for the use of TXA in spine surgery as it reduces the overall blood loss and transfusion requirements.Conclusion:As the volume and complexity of spinal procedures rise, intraoperative blood loss management has become a pivotal topic of research within the field. There are many tools for minimizing blood loss in patients undergoing spine surgery. The current literature supports combining techniques to use a cost- effective multimodal approach to minimize blood loss in the perioperative period.

Effect of the Ultrasonic Bone Scalpel on Blood Loss During Pediatric Spinal Deformity Correction Surgery

Study DesignRetrospective cohort. ObjectiveDetermine the effect of the ultrasonic bone scalpel (UBS) on intraoperative blood loss and surgical time. Summary of Background DataThe UBS has shown beneficial effects in limiting blood loss in spinal surgery, but no study has examined its effect in patients with neuromuscular scoliosis. MethodsClinical records were reviewed for patients aged 9–18 who underwent posterior spinal fusion surgery of five or more levels for scoliosis correction by the senior author from April 2013 until October 2016. Exclusion criteria included: vertebral column resections, previous spinal surgery, cell saver usage, cases complicated by signal loss on monitoring, and incomplete medical records. A total of 84 patients met the criteria and were included in data analysis. The UBS was routinely used for performing osteotomies and facetectomies for all cases operated after March 2015. These cases were compared to a control group who underwent surgery prior to this date in which the UBS was not used. The experimental and control groups were further divided into adolescent idiopathic (AIS) and neuromuscular (NMS) subgroups. ResultsEBL in AIS patients decreased from 1,211 mL in the control group to 771 mL in the UBS group for an average total reduction of 440 mL (95% CI 106, 774, p = .01). In NMS patients, EBL fell from 2,171 mL in controls to 1228 mL in the study group for an average total reduction of 943 mL (95% CI 288, 1598, p < .01). On controlling for weight and number of levels fused, blood loss decreased 26.2% in AIS patients and 46.2% in NMS patients. ConclusionsThe ultrasonic bone scalpel is effective in reducing blood loss in AIS and NMS deformity correction surgery. Surgical time is not adversely affected by its use. Level of EvidenceLevel II, cohort study.

Effectiveness and Safety of Batroxobin, Tranexamic Acid and a Combination in Reduction of Blood Loss in Lumbar Spinal Fusion Surgery.

A prospective randomized double blind placebo controlled trail. To evaluate and compare the efficacy and safety of batroxobin (botropase), tranexamic acid (TXA), and their combination in reduction of perioperative blood loss in lumbar spine single level fusion surgeries. Spinal surgeries are associated with significant blood loss leading to perioperative anemia and increased need for allogenic transfusion. TXA competitively inhibits plasmin and batroxobin converts fibrinogen to fibrin and theoretically their combination is synergistic. Though TXA is widely studied in controlling blood loss, there is little information on use of batroxobin and their combination. Thus, we aimed to study effect and safety of individual drugs and their combination in controlling blood loss in spinal surgery. Hundred patients were randomized into four groups. Group B received batroxobin, group T received TXA, group BT received batroxobin and TXA and group P received placebo. Outcomes assessed are intraoperative and postoperative blood loss, hematocrit, allogenic blood transfusion, and deep vein thrombosis (DVT), postoperatively. Mean intraoperative blood loss in Group B, T, BT, and P were 268.32 ± 62.92 mL, 340.72 ± 182.75 mL, 256.96 ± 82.64 mL, and 448.44 ± 205.86 mL, respectively. Postoperative surgical site drain collection in Group B, T, BT, and P were 218.00 ± 100.54 mL, 260.40 ± 100.85 mL, 191.00 ± 87.84 mL, and 320.00 ± 125.83 mL, respectively. Intraoperative blood loss of Group P was statistically higher than Groups B and BT (P < 0.001). Mean postoperative surgical site drain collection was statistically significant (P < 0.001). No statistically significant differences in fluid administration (P = 0.751), blood transfusion (P = 1.000), preoperative and postoperative hemoglobin (P = 0.090, P = 0.134, respectively), and deep vein thrombosis (P = 1.000). Batroxobin and combination of batroxobin with tranexamic acid significantly reduced perioperative blood loss when compared with placebo. 2.

Aspirin therapy discontinuation and intraoperative blood loss in spinal surgery: a systematic review.

The purpose of this study was to determine the effect of aspirin therapy discontinuation on intraoperative blood loss in spinal surgery. We searched Medline and Google Scholar 1946 to January 2017 inclusive for case-control studies, cohort studies, and controlled trials reporting intraoperative blood loss during spinal surgery in patients on pre-operative aspirin. Other outcome measures reported in the eligible studies were collected as secondary outcomes. Two reviewers independently screened and extracted data from each study. Five retrospective cohort and two case-control studies were eligible for inclusion. Of the 1173 patients identified, 587 patients were never on aspirin (Ax), 416 patients had aspirin discontinued before surgery (Ad), ranging from 3 to 10days, and 170 patients had aspirin continued until surgery (Ac). Six out of seven studies reported no statistically significant difference in intraoperative blood loss irrespective of aspirin discontinuation. Meta-analysis was not possible due to high risk of bias. Of the secondary outcome measures, operative time and postoperative complications were most commonly reported. One of six studies evaluating operative time reported a significantly longer operative time in the Ad group compared with the Ac group. The overall risk of postoperative haematoma in Ax, Ad, and Ac groups is 0.2% (n/N = 1/587), 0.2% (n/N = 1/416), and 1.2% (n/N = 2/170), respectively. No study reported a statistically significant difference in postoperative complications. There is no strong evidence demonstrating a difference in intraoperative blood loss, operation time, and postoperative complications, irrespective of aspirin discontinuation. This is, however, based on a limited number of studies and higher-quality research is required to answer this question with a higher degree of confidence.

Surgical treatment of spinal metastases from renal cell carcinoma-effects of preoperative embolization on intraoperative blood loss.

The objective of this paper is analyzing the effects of preoperative embolization on intraoperative blood loss in spinal surgery for renal cell carcinoma (RCC) metastasis and identifying factors contributing to an increased blood loss in the surgical procedure. A retrospective analysis was performed in patients who were treated in for spinal metastasis from RCC between 2011 and 2016. Factors analyzed were reduction of tumor blush, timing of embolization, selective vs. superselective approach, surgical factors, and tumor volume and localization. Parameters were statistically correlated with intraoperative blood loss (hemoglobin (Hg) decrease, blood loss in milliliters, number of transfused blood bags). Twenty-five patients with 34 surgical interventions were included. Seventeen cases were treated superselectively and 11 treated selectively. Mean perioperative blood loss was 2248 ± 1833ml. Higher blood loss was detected for vertebra replacement compared to percutaneous procedures (Hg decrease 4.22 vs. 2.62, p < 0.05). Blood loss increased with increasing tumor volumes (0-50ccm/50-100ccm/> 100ccm) for Hg loss (3.29/3.64/4.24mg/dl, NS), blood loss in milliliters (1291/2620/4971ml, p < 0.001), and number of transfusions (1.2/3.4/7.0, p < 0.001). Stratifying by the grade of embolization, no significant differences were found between the groups (> 90%/90-75%/75-50%) for Hg loss, blood loss, or number of transfusions. Endovascular embolization for RCC metastasis of the spine is a safe procedure; however, in this cohort, patients undergoing embolization did not show a reduced blood loss in comparison to the non-embolized cohort. Additional factors contributing to an increased blood loss were tumor size and mode of surgery.

Perioperative Management of Blood Loss in Spine Surgery.

Spine procedures are associated with high rates of blood loss which can result in a greater need for transfusions. Repeated exposure to blood products is associated with risks and adverse reactions such as transfusion-related acute lung injury, fluid shifting, and infections. With the higher number of spine procedures and the increasing open surgery times associated with difficult procedures, excessive blood loss has become more prevalent. Perioperative methods have been established to combat the excessive blood loss and decrease the need for blood products. Preoperatively, anemia and coagulopathy screening is standard at least 4 weeks before elective procedures. Erythropoietin, iron loading or transfusions are used to decrease preoperative anemia, a predisposing factor for blood loss. Autologous predonation of blood has been shown to be ineffective and decreases preoperative hemoglobin levels. Intraoperatively, antifibrinolytics such as tranexamic acid and aminocaproic acid are used to decrease blood loss. In addition, fibrinogen concentrates, thromboelastometry, acute normovolemic hemodilution, controlled hypotension, and temperature regulation are some of the techniques used to decrease blood loss and the need for transfusions. Postoperatively, fibrin sealants, shed blood salvage, and erythropoietin or intravenous iron are used in management of blood loss, especially in instances when the patient refuses blood products.

The effectiveness of low-dose and high-dose tranexamic acid in posterior lumbar interbody fusion: a double-blinded, placebo-controlled randomized study.

Tranexamic acid is a proven drug used for reduction of intraoperative blood loss in spinal surgery. However, optimal dosing considering risk/benefits is not well established owing to the heterogeneity in patient selection and surgical procedures of previous studies. This study aimed to evaluate the effectiveness and safety of various tranexamic acid regimens in reducing perioperative blood loss in single-level posterior lumbar interbody fusion (PLIF). Patients were randomly grouped into three different interventions: low-dose tranexamic acid (LD), high-dose tranexamic acid (HD), and placebo-controlled (PC) groups. The HD and LD groups received 10 and 5mg/kg of bolus loading dose and 2 and 1mg/kg of continuous infusion until 5h after surgery, respectively. Data on patient demographics and preoperative and 24-h postoperative laboratory values were collected. Outcome parameters include intraoperative blood loss, 24-h postoperative blood loss, and blood loss during removal of the last drain. Seventy-two patients (mean age 63.3±7.6years) showed similar baseline characteristics. Intraoperatively, blood loss was reduced by the administration of tranexamic acid (P=0.04), contributed predominantly by a difference between the LD and HD groups (123mL; P<0.01). The 24-h postoperative blood loss was reduced (P<0.01), contributed predominantly by a difference between the PC and LD groups (144mL; P=0.02). During the removal of the last drain, statistical difference was found between the PC and HD groups (125mL; P=0.00). No complications or side effects from tranexamic acid use were noted. Tranexamic acid administration for single-level PLIF was effective and safe in reducing perioperative blood loss in a dose-dependent manner. An HD regimen comprising 10mg/kg of bolus loading dose and 2mg/kg/h of continuous infusion is recommended. Level 1 study according to Oxford Centre for Evidence-Based Medicine 2011 Levels of Evidence.

The efficacy of bipolar sealer on blood loss in spine surgery: a meta-analysis

The purpose of this meta-analysis of randomized controlled trials (RCTs) and non-RCTs was to gather data to evaluate the efficacy and safety of bipolar sealer versus standard electrocautery in the management of spinal disease. The electronic databases including Embase, PubMed and Cochrane library were searched to identify relevant studies published from the time of the establishment of these databases up to January 2017. The primary outcomes were total blood loss, requirement of transfusion (rate and amount), and operation time. The secondary outcomes were length of hospital stay and postoperative wound infection. Data analysis was conducted with RevMan 5.3 software. A total of five studies involving 500 patients (261 patients in the BS group and 239 in the control group) were included in the meta-analysis. The pooled results revealed that application of bipolar sealer could decrease the total blood loss in spine surgery [WMD=-467.49, 95% CI (685.47 to -249.51); p<0.05; I 2=91%]. Compared with standard electrocautery, bipolar sealer was associated with lower rates of need for transfusion [OR=0.30, 95% CI (0.16-0.55), p<0.05; I 2=0%]. In addition, patients in the BS group were likely to receive less amount of blood transfusion compared with patients in the control group[WMD=-0.73, 95% CI (-1.37 to -0.09), p < 0.05; I 2=76%]. The mean operative time was shorter in the BS groups compared with the control group [SMD=-0.36, 95% CI (-0.60 to -0.13), p<0.05; I 2=0%]. There was no significant difference in terms of length of hospital stay [WMD=-0.73, 95% CI (-1.96 to 0.51), p=0.25; I 2=67%] and postoperative wound infection [OR=0.88, 95% CI (0.31-2.48), p=0.81; I 2=0.0%] between both groups. The available evidence suggests that bipolar sealer is superior to standard electrocautery with less blood loss, shorter operation time and less transfusion requirement. There is no significant difference between both groups regarding length of hospitalization and wound infection. Hence, bipolar sealer is recommended in spine surgery. Because of the limitation of our study, more well-designed RCTs with large sample are required to provide further evidence of safety and efficacy between bipolar sealer and standard electrocautery in the treatment of spinal disease.

Research progress on associated factors about blood loss in spinal surgery for adolescent scoliosis

Background Massive blood loss in spinal surgery for adolescent scoliosis is a major concern for anesthesiologists. Researches have found factors associated with blood loss and built multivariate regression models. Objective This article is a summary of factors associated with blood loss in spinal surgery for adolescent scoliosis, and an analysis about the effect of these factors. Content Significant factors affecting intraoperative blood loss of spinal surgery for adolescent scoliosis mainly include sex, weight, diagnostic type of scoliosis, Cobb angle, number of levels fused, osteotomy, duration of operation, fibrinogen(FG), activated partial thromboplastin time(APTT), menstrual phase, antifibrinolytics. Trend More prospective researches with large sample size in multicenter are needed to identify validity, reliability and effectiveness of these factors and models. Key words: Adolescent; Scoliosis; Blood loss

Canadian Consensus for the Prevention of Blood Loss in Spine Surgery.

Cross-sectional, modified Delphi approach. The primary objective of this study was to identify patients at risk of increased perioperative blood loss according to the opinion of expert spine surgeons across Canada. The secondary objective was to obtain information about the experts' approach on how to minimize significant blood loss perioperatively. Significant blood loss in major spinal surgeries has been associated with increased intra- and perioperative complications and costs. The current available evidence regarding risk factors and preventive measures for increased blood loss remains incomplete. A modified Delphi approach was employed to generate consensus opinion on the risk factors and preventive measures for significant blood loss in major spinal surgeries. Twenty-five spine surgeons in Canada participated in this study. Among various factors, surgery for the treatment of spine tumors and prolonged operative time of greater than 5 hours were found to be the most important predictive factors for blood loss in spine surgery. On the other hand, appropriate surgical hemostasis was considered the most effective measure for the prevention of blood loss in these surgeries. We recommend the reduction of blood loss by means of meticulous hemostasis and shorter operative time when it is safe and possible. This might result in better treatment outcomes. It would also lead to a reduction in costs associated with major spine surgeries and would ultimately lead to greater value-based spine care. 4.

Surgical treatment of patients with lung cancer and bone metastases: a prospective, observational study

BackgroundAs life expectancy improves in patients with lung cancer and bone metastases, effective surgical treatment to relieve pain and improve quality of life and neurological function is increasingly needed. Indications for surgery in patients with bone metastases are controversial. We aimed to assess a protocol for the surgery of patients with lung cancer and bone metastases. MethodsWe developed a surgical protocol for both spinal and appendicular metastases. According to the aim of surgery, eligible patients were placed into four classes (class 1: solitary metastatic bone lesion; class 2: spinal cord compression or pathological fracture; class 3: impending fracture; and class 4: severe pain after medical treatment or radiation). We assessed mobility and neurological functions 1 day before and 1 week, 1 month, 3 months, and 6 months after surgery with the visual analog scale for pain (VAS; scale 1–10), Karnofsky performance status scale (KPS), mobility scale with a score of 0 representing no limitation, a score of 1 representing limitation without the need for orthopaedic aids, a score of 2 representing limitation necessitating orthopaedic aids, and a score of 3 representing bedridden operative technique. Kaplan-Meier analysis was used to calculate survival. This study was approved by the ethics committee of the Sixth People's Hospital, Shanghai Jiao Tong University. Written informed consent was provided by the patient or their legal guardian. FindingsBetween Jan 1, 2005 and Jan 1, 2014, 134 patients underwent surgery (49 spine lesions and 86 appendicular skeleton lesions; one patient was operated in both lumbar and pelvis). VAS decreased after surgery (mean score 6·58 [SD 1·12] before vs 5·33 [1·38] at 1 week, 4·39 [1·35] at 1 month, 3·71 [1·29] at 3 months, and 3·99 [1·02] at 6 months, all p<0·0001 vs baseline). KPS and mobility scale scores were decreased 1 week after surgery (KPS 69·2 [SD 8·8] vs 65·4 [9·1], p=0·0012; mobility scale score (0/1/2/3) 32/47/34/21 vs 19/43/48/23, p<0·0001), and returned to preoperative levels at 1 month for appendicular surgery (KPS 67·2 [10·1] and mobility 21/34/19/11) or 3 months for spinal surgery (KPS 70·8 [11·7] and mobility 21/13/11/4). Mobility scale scores increased at 3 months and 6 months after surgery (48/46/26/12 at 3 months, p<0·0001; 54/39/21/6 at 6 months, p<0·0001). Frankel classification in patients with spinal metastases also improved at 3 months and 6 months after surgery (D/C/B/A from 17/5/3/4 to 12/4/3/2 and 19/0/0/1; p=0·0234 and p=0·0114), as did Musculo-Skeletal Tumor Society rating scale (MSTS) scores in patients with appendicular metastases (from 14·8 [6·1] 1 week after surgery to 20·3 [5·8] at 1 month, 24·1 [4·3] at 3 months, and 22·6 [5·5] at 6 months; all p<0·05 vs 1 week postoperative). The amounts of blood loss in spinal surgery were larger than appendicular surgery (mean 1620 mL [SD 1078] vs 571 mL [775]; p<0·0001). Median overall survival time after surgery was 13·5 months [SD 0·8]. Survival time in the group aimed at radical cure (Class 1: 27·0 months [3·5]) was significantly longer than the other three group (Class 2: 12·6 months [1·0]; Class 3: 13·1 months [1·0]; Class 4: 9·6 months [0·7]; p<0·0001). InterpretationAppropriate surgery provides pain relief, improvement of quality-of-life, and increased neurological function with an acceptably low rate of complications. Our protocol enabled physicians to identify patients with lung cancer and bone metastases who might be candidates for radical surgery. FundingNational Natural Science Foundation of China Grant (81201628).

Effectiveness of tranexamic acid in reducing blood loss in spinal surgery: a meta-analysis.

BackgroundThe aim of present meta-analysis was to evaluate the effectiveness of tranexamic acid (TXA) use in reducing blood loss and the related thrombotic complications in spinal surgery.MethodsThree databases (MEDLINE, EMBASE, and the Cochrane Library) were searched through October 2012 to identify the relevant randomized controlled trials (RCTs) regarding the TXA effective in spinal surgery. Mean differences (MDs) of blood loss, blood transfusions, and postoperative partial thromboplastic time (PTT), odds ratios (ORs) of blood transfusion and thrombotic complication in TXA-treated group compared to placebo group were extracted and combined using random-effect meta-analysis.ResultsA total of 6 RCTs comprising 411 patients were included in the meta-analysis according to the pre-defined selection criteria. TXA-treated group had significantly less amount of blood loss and blood transfusions per patient, and had smaller proportion of patients who required a blood transfusion compared with the placebo group. The use of TXA can significantly reduce the postoperative PTT with weighted MD of -1.59 [(95% confidence interval (CI):-3.07, -0.10] There is a null association between thrombosis complications and the use of TXA.ConclusionWe conclude that the use of TXA in patients undergoing spinal surgery appears to be effective in reducing the amount of blood loss, the volume of blood transfusion, the transfusion rate, and the postoperative PTT. However, data were too limited for any conclusions regarding safety. More high-quality RCTs are required before recommending the administered of TXA in spinal surgery.Electronic supplementary materialThe online version of this article (doi:10.1186/1471-2474-15-448) contains supplementary material, which is available to authorized users.

Use of labetalol and glyceryl trinitrate for induced hypotension in spine surgery- A comparative study

Background: Induced hypotension is used to reduce blood loss especially in those operations where even a small amount of blood can obscure the operative field such as spine surgery. Objectives: To compare the effect of labetalol with that of glyceryl trinitrate to reduce intraoperative blood loss by inducing elective hypotension without any tachycardia and to improve quality of surgical field during spine surgery. Method: A total number of thirty patients (ASA grade I &amp; II) were selected randomly into two groups, fifteen in each group. Group-I received glyceryl tinitrate (1000?g) and Group-II received labetalol (5mg) intravenously 3 minutes before induction of anaesthesia. Heart rate, mean arterial pressure was observed in two study groups 15 minutes interval in intra-operative period and quality of surgical field was detected by 4 points VRS (Verbal rating scale) after completion of surgery by asking the surgeon. Results: Heart rate varied significantly in two study groups after induction of anaesthesia except baseline and pre induction (p&lt; 0.05). Labetalol associated with improved quality of surgical field visualization than glyceryltrinitrate (p = 0.034). Conclusion: Our study concluded that labetalol is effective than glyceryltrinitrate to reduce blood loss in spine surgery. DOI: http://dx.doi.org/10.3329/jbsa.v22i2.18141 Journal of BSA, 2009; 22(2): 48-53

Decreasing Blood Loss in Spinal Surgery with Tranexamic Acid

Decreasing Blood Loss in Spinal Surgery with Tranexamic Acid

Efficacy of Prophylactic Tranexamic Acid for Blood Loss in Spinal Surgery

Efficacy of Prophylactic Tranexamic Acid for Blood Loss in Spinal Surgery

Effect of Clonidine Premedication on Blood Loss in Spine Surgery

Background: Blood loss in spine surgery is an important issue, even though it has been understudied compared with hip and knee arthroplasty. Objectives: In this study, we evaluated the effect of oral clonidine as premedication on blood loss in lumbar spine fusion surgery under anesthesia with propofol and remifentanil. Patients and Methods: In this double-blind, randomized clinical trial, 30 patients who were undergoing lumbar spine posterior fusion surgery due to traumatic fracture were allocated randomly into 2 groups. The study group (clonidine group) received a 200-μg oral clonidine tablet 60–90 minutes before anesthesia, and the control group received placebo at the same time. Induction and maintenance of anesthesia and the mean target arterial pressure for controlled hypotension with remifentanil were the same in the 2 groups. We compared the amount of intraoperative blood loss, dose of remifentanil/hour administered, need for nitroglycerine to reach the mean target arterial pressure when remifentanil was insufficient, duration of operation, and surgeon’s satisfaction of a bloodless field between groups. Results: There was no statistically significant difference between groups in age (P = 0.115), sex (P = 0.439), weight (P = 0.899), operation time (P = 0.2), or American Society of Anesthesiologists physical status score (P = 0.390). Conclusions: As an oral premedication, clonidine can reduce surgical blood loss in lumbar spine posterior fusion surgery, even at the same levels of mean arterial pressure (MAP) with the control group. Its use can be studied in more complicated spine surgeries, such as scoliosis and spinal deformity surgeries.

Effect of clonidine premedication on blood loss in spine surgery.

Background:Blood loss in spine surgery is an important issue, even though it has been understudied compared with hip and knee arthroplasty.Objectives:In this study, we evaluated the effect of oral clonidine as premedication on blood loss in lumbar spine fusion surgery under anesthesia with propofol and remifentanil.Patients and Methods:In this double-blind, randomized clinical trial, 30 patients who were undergoing lumbar spine posterior fusion surgery due to traumatic fracture were allocated randomly into 2 groups. The study group (clonidine group) received a 200-μg oral clonidine tablet 60–90 minutes before anesthesia, and the control group received placebo at the same time. Induction and maintenance of anesthesia and the mean target arterial pressure for controlled hypotension with remifentanil were the same in the 2 groups. We compared the amount of intraoperative blood loss, dose of remifentanil/hour administered, need for nitroglycerine to reach the mean target arterial pressure when remifentanil was insufficient, duration of operation, and surgeon’s satisfaction of a bloodless field between groups.Results:There was no statistically significant difference between groups in age (P = 0.115), sex (P = 0.439), weight (P = 0.899), operation time (P = 0.2), or American Society of Anesthesiologists physical status score (P = 0.390).Intraoperative blood loss and remifentanil dose administered per hour in the clonidine group were significantly less than in the control group (P = 0.002 and P = 0.001, respectively), but there was no significant difference in surgeon’s satisfaction between groups (P = 0.169).Conclusions:As an oral premedication, clonidine can reduce surgical blood loss in lumbar spine posterior fusion surgery, even at the same levels of mean arterial pressure (MAP) with the control group. Its use can be studied in more complicated spine surgeries, such as scoliosis and spinal deformity surgeries.