1.
Effect of Multifunctional Cocktail Topical Applicated for Spinal Fusion on Postoperative Bleeding and Pain Control-A Prospective, Randomized, Double-Blind Controlled Trial
Jiang W, Fu M, Dong W, Zhou N, Shen J, Zhang X, Hao J
Spine. 2021
Abstract
MINI: Bleeding and pain following lumbar fusion surgery remains a challenge for orthopedists. We designed a prospective, randomized, double-blind controlled trial and confirmed that the topical application of multifunctional cocktail we designed provide an effective and safe method for simultaneously reducing pain and bleeding after spinal fusion. STUDY DESIGN A prospective, randomized, double-blind controlled trial. OBJECTIVE To explore the effect of multifunctional cocktail for bleeding and pain control after spinal fusion. SUMMARY OF BACKGROUND DATA Managing postoperative bleeding and pain following spinal fusion remains a challenge. Topical application of tranexamic acid (TXA) or anaesthetic agents for bleeding or pain management just started recently, and the multifunctional cocktail for bleeding and pain control simultaneously after spinal fusion have never been published. METHODS 90 patients who underwent posterior spinal fusion were enrolled in this study. The multifunctional cocktail was injected into the incision before wound closure in the cocktail group. In the control group, an equal volume of normal saline was injected and a patient-controlled analgesic (PCA) pump was used. Visual analogue scale (VAS) score; opioid consumption; intraoperative, postoperative, hidden and total blood loss (IBL, PBL, HBL, and TBL); volume of drainage (WD), haematocrit (Hct) levels of drainage; haemoglobin (Hb) levels; and complications were compared between the two groups. RESULTS There were no differences in the VAS within 48 h after surgery between the two groups. However, the opioid dosages in the control group were higher than those in the cocktail group. The PBL, TBL and HBL were lower in the cocktail group than in the control group. The drainage volume showed no differences between the two groups; however, the Hct level of drainage at 24 h after surgery was lower in the cocktail group than in the control group. The Hb level was higher in the cocktail group than in the control group at POD3. Thirteen patients with unbearable nausea and vomiting in the control group, while no complications in the cocktail group. CONCLUSION Topical application of a multifunctional cocktail that we designed provides an effective and safe method for reducing pain and bleeding after spinal fusion.Level of Evidence: 1.
2.
The influence of topical use of tranexamic acid in reducing blood loss on early operation for thoracolumbar burst fracture: a randomized double-blinded controlled study
Shen J, Yang Z, Fu M, Hao J, Jiang W
European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society. 2020;:1-7
Abstract
PURPOSE To investigate the safety and efficacy of topical use of tranexamic acid (TXA) on early operation for thoracolumbar burst fracture (TBF). METHODS Patients with acute TBF requiring early decompression were prospectively collected. The enrolled patients were randomly assigned to TXA and control group, in which wound surface was soaked with TXA or the same volume of normal saline for 5 min after wound incision, respectively. The total blood loss (TBL), intraoperative blood loss (IBL), postoperative blood loss (PBL), hemoglobin (HGB) levels on preoperatively (pre-op) and postoperatively, and amount of allogenic blood transfusion were recorded. Furthermore, the general information was also compared between groups. RESULTS There were 39 and 37 patients enrolled in TXA and control group for final analysis. The demographics data showed no significant difference between groups (P > 0.05), but operation time and IBL were significantly decreased in TXA group (P < 0.05). Further analysis showed that HGB level was significantly higher in the TXA group at POD1, while the TBL and PBL were significantly less than those in the control group (P < 0.05), but similar to HBL (P > 0.05). The postoperative ambulation time, removal time of drainage tube, length of hospital stay, and blood transfusion rate were also significantly less in TXA group (P < 0.05). At the final follow-up, no neurological deteriorations and no TXA-related complications were observed in both groups. CONCLUSION This RCT first demonstrated that topical TXA usage after wound incision could effectively reduce IBL without increasing risk of complications, beneficial to enhanced recovery after early operation for TBF.