-
1.
Local Application of Tranexamic Acid in Plastic Surgery Patients: A Systematic Review and Meta-Analysis of Randomized Controlled Trials
Wang S, Yang J, Lin L
Aesthetic plastic surgery. 2023
Abstract
BACKGROUND According to recent evidence, the use of local tranexamic acid (TXA) during plastic surgery may lessen blood loss. OBJECTIVES To comprehensively assess the use of local TXA during plastic surgery through a systematic review and meta-analysis of randomized controlled trials addressing these issues. METHODS Four electronic databases, including PubMed, Web of Science, Embase and the Cochrane Library, were searched until December 12, 2022. Following meta-analyses, the mean difference (MD) or standardized mean difference (SMD) for blood loss volume (BLV), ΔHct, ΔHb and operation time were calculated when appropriate. RESULTS Eleven randomized controlled trials were included in the qualitative synthesis, while 8 studies were included in the meta-analysis. Compared with the control group, the local TXA group showed a reduction in blood loss volume of -1.05 (p < 0.00001; 95% CI, -1.72 to -0.38). However, local TXA had a limited effect on reducing ΔHct, ΔHb and operation time. A meta-analysis was not performed because of heterogeneity in other outcomes; however, except for 1 study in which no significant difference was observed on POD 1, all studies showed significantly lower rates of postoperative ecchymosis after surgery, 2 studies showed statistically significant reductions in transfusion risk or volume, and 3 studies reported significantly better surgical field quality in operations with local TXA. In the 2 included studies, the researchers concluded that local treatment does not play a role in relieving postoperative pain. CONCLUSIONS Local TXA is associated with less blood loss, less ecchymosis and better surgical field in plastic surgery patients. LEVEL OF EVIDENCE I This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
-
2.
Synergistic Effect of a Prolonged Combination Course of Tranexamic Acid and Dexamethasone Involving High Initial Doses in Total Knee Arthroplasty: A Randomized Controlled Trial
Xu H, Xie J, Yang J, Huang Z, Wang D, Pei F
The journal of knee surgery. 2021
Abstract
The optimal regimes of tranexamic acid (TXA) and dexamethasone (DXM) in total knee arthroplasty (TKA) are still uncertain. The aim of this study was to assess the efficacy and safety of a prolonged course of intravenous TXA and DXM involving a high initial dose in TKA. Patients who underwent primary TKA at our center were randomized to receive one of four regimes: control (group A), prolonged course of TXA (B), prolonged course of DXM (C), or the combination of a prolonged course of TXA and DXM (D). The four groups were compared in primary outcomes (fibrinolytic and inflammatory markers, knee function, postoperative pain levels, and consumption of opioids) and secondary outcomes (blood loss, maximal drop in hemoglobin, coagulation, fasting blood glucose, and complications). A total of 162 patients were enrolled. On postoperative days 2 and 3, fibrinolytic markers were lower in groups B and D than in groups A and C; inflammatory markers were lower in groups C and D than in groups A and B. Inflammatory markers were lower in group B than in group A on postoperative day 3. Postoperative pain levels and oxycodone consumption were lower, and knee function was better in groups C and D. The four groups did not differ in any of the secondary outcomes. A prolonged course of intravenous TXA and DXM involving high initial doses can effectively inhibit postoperative fibrinolytic and inflammatory responses, reduce pain, and improve knee function after TKA.
-
3.
Drainage relieves pain without increasing post-operative blood loss in high tibial osteotomy: a prospective randomized controlled study
Li S, Yang J, Watson C, Lu Q, Zhang M, Miao Z, Luo D, Liu P
Int Orthop. 2020
Abstract
PURPOSE Drainage is a common procedure in high tibial osteotomy (HTO), but the benefits of drainage during HTO remain poorly investigated. This study was designed to investigate the effect of drainage on blood loss and early functional recovery in HTO. METHODS Altogether, 80 patients undergoing HTO were analyzed from August 2018 to September 2019. Patients were randomized into two groups: group A (drainage, n = 40) and group B (no drainage, n = 40). There were no intergroup differences in baseline parameters between the two groups, and the same surgical techniques and haemostatic methods were used. The mean follow-up time was 3.2 months. Blood loss and early functional recovery of the knee were examined post-operatively in both groups. RESULTS The total post-operative blood loss was 253.34 +/- 104.18 ml in group A and 222.51 +/- 106.89 ml in group B. This difference was non-significant (p > 0.05). The post-operative haemoglobin and haematocrit differences between groups were also non-significant (p > 0.05). Post-operative visual analogue scale (VAS) pain scores and lower leg swelling were lower in group A than those in group B (p < 0.05), and the early range of motion of the knee joint was higher in group A than that in group B (p < 0.05). Group A had lower incidence rates of dressing seepage and incision complications than group B (p < 0.05). The differences in three month post-operative VAS and knee function scores were non-significant (p > 0.05). CONCLUSION Drainage in HTO does not increase patients' total blood loss, but it can promote early knee function recovery by reducing post-operative pain, lower leg swelling, and the incidence of incision complications. TRIAL REGISTRATION NCT-03954860.
-
4.
[Micro-fracture therapy combined with intra-articular injection of platelet-rich plasma for small sized osteochondral lesion of the talus]
Yang J
Zhongguo xiu fu chong jian wai ke za zhi = Zhongguo xiufu chongjian waike zazhi = Chinese journal of reparative and reconstructive surgery. 2020;34(1):53-56
Abstract
Objective: To investigate the effectiveness of micro-fracture therapy combined with intra-articular injection of platelet-rich plasma (PRP) in the treatment of small sized osteochondral lesion of the talus (OLT). Methods: Between September 2014 and October 2017, 43 patients with small sized OLT met the inclusive criteria were admitted and randomly divided into micro-fracture group (21 cases) and combined group (22 cases). Patients in the micro-fracture group were treated with micro-fracture therapy, and patients in the combined group were treated with micro-fracture therapy combined with intra-articular injection of PRP. There was no significant difference in gender, age, disease duration, side of OLT, injured position, lesion area, Mintz classification, and preoperative American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hind foot score and visual analogue scale (VAS) score between the two groups ( P>0.05). After treatment, MRI, VAS score, and AOFAS ankle-hind foot score were used to evaluate the recovery of OLT and the ankle function. Results: All incisions healed by first intention, and no complications such as venous thrombosis and ankle joint infection occurred. All patients were followed up 12-18 months after operation, with an average of 15.6 months. The VAS scores and the AOFAS ankle-hind foot scores were significantly improved at 6 and 12 months after operation in the two groups ( P<0.05), and the scores at 12 months were significantly improved when compared with postoperative scores at 6 months ( P<0.05). Compared with the micro-fracture group, the VAS score and the AOFAS ankle-hind foot score were significantly improved in the combined group at 6 and 12 months after operation ( P<0.05). MRI showed that OLT was well filled in both groups at 12 months after operation. Conclusion: Compared with micro- fracture therapy, micro-fracture therapy combined with intra-articular injection of PRP can effectively reduce pain, improve ankle function, and has a good effectiveness in the treatment of small sized OLT.
-
5.
[Influences of acute hypervolemic hemodilution on serum levels of S-100beta protein, NSE and POCD in elderly patients with spinal surgery]
Xu P, Yang J, Liu Z, Qi W, Qi F
Zhongguo Gu Shang. 2019;32(10):923-927
Abstract
OBJECTIVE To explore the influences of acute hypervolemic hemodilution(AHH) on serum levels of S-100beta protein, neuron specific enolase(NSE) and postoperative cognitive dysfunction POCD in elderly patients with spinal surgery. METHODS A total of 80 cases elderly patients requiring elective spinal operation were divided into AHH group and C group according to random digits table, 40 cases in each group, with ASA grade I-II. The patients in AHH group were infused 6% hydroxyethyl starch 130/0.4 at a rate of 20 ml/min after anesthesia induction, and blood volume increased by about 20%, the patients in C group were not received AHH, anesthesia and surgical methods were the same as those in AHH group. Intraoperative blood volume, allogeneic blood transfusion and urine volume were recorded. Mean arterial pressure(MAP), heart rate(HR), central venous pressure(CVP) at preoperative 1 d, 1 h after the start of surgery, end of operation, 12 h after surgery were observed. Arterial blood oxygen content (CaO(2)), venous blood oxygen content (CjvO(2)), arteriovenous oxygen content difference (Da-jvO(2)), and cerebral oxygen uptake(CERO(2)) were measured at 1 d before surgery, 15 min after surgery, 45 min after surgery, end of surgery. Mini-mental state examination(MMSE) score and serum levels of S-100beta protein, NSE were measured at 1 d before surgery, 1, 3, 7 d after surgery. POCD rates of two groups were recorded. RESULTS Intraoperative blood loss and allogeneic blood transfusion in AHH group was significantly lower than those in C group(P<0.05), and the urine volume was significantly higher than that in C group (P<0.05). Compared with preoperative 1 day, MAP was decreased and CVP was increased at end of surgery in AHH group, compared with C group at the same time, MAP was lower and CVP was higher in AHH group, but both were in normal range. Compared with preoperative 1 day and C group, the levels of Da-jvO(2) and CERO(2) in AHH group was decreased at 15, 45 min after the start of the operation and end of surgery(P<0.05). Compared with preoperative 1 day, MMSE scores of two groups at 1 day after surgery was decreased (P<0.05), the levels of S-100beta protein and NSE were increased(P<0.05), and restored at 3, 7 days after surgery. There was statistical difference in MMSE scores, the levels of S-100beta protein, NSE at 1 day after surgery between two groups (P<0.05). There was no statistical difference in POCD rate between two groups(P>0.05). CONCLUSIONS AHH can significantly reduce intraoperative blood loss and blood transfusion in elderly patients with spinal surgery, and decrease the levels of S-100beta protein and NSE, does not increase the risk of the occurrence of POCD.
-
6.
Influence of tourniquet use in primary total knee arthroplasty with drainage: a prospective randomised controlled trial
Zhou K, Ling T, Wang H, Zhou Z, Shen B, Yang J, Kang P, Pei F
Journal of Orthopaedic Surgery and Research. 2017;12((1)):172.
Abstract
BACKGROUND We aimed to compare the effect of tourniquet use or lack of it on recovery following uncomplicated primary total knee arthroplasty (TKA). METHODS In a prospective randomised double-blinded study, 150 patients undergoing primary TKA were assigned to either a tourniquet or non-tourniquet group. At the early phase, 3 and 6 months after surgery, an independent observer assessed the primary outcome measure (i.e. total blood loss) and secondary outcome measures (i.e. wound complications, visual analogue scale pain score and knee range of motion). RESULTS The tourniquet group exhibited reduced intraoperative blood loss (215.7 +/- 113.7 ml vs. 138.6 +/- 93.9 ml, P < 0.001) and shorter operating time (77.2 +/- 14.5 min vs. 82.0 +/- 12.7 min, P = 0.038). However, the non-tourniquet group showed less postoperative blood loss (180.2 +/- 117.0 ml vs. 253.7 +/- 144.2 ml, P = 0.001) and drainage volume (89.2 +/- 66.3 ml vs. 164.5 +/- 97.8 ml, P = 0.004), less thigh pain (all P < 0.001) in the initial 3 weeks, better knee range of motion (ROM) in the initial 3 days (day 1 81.6 +/- 17.1 vs. 75.95 +/- 14.55, P = 0.036; day 3 99.8 +/- 13.7 vs. 93.95 +/- 11.15, P = 0.005) and fewer wound tension vesicles (10.3 vs. 29.2%, P = 0.005). Earlier straight-leg raising (4.6 +/- 3.8 h vs. 6.4 +/- 4.3 h, P = 0.01) and shorter length of stay (6.3 +/- 1.7 days vs. 7.1 +/- 1.9 days, P = 0.001) were found in the non-tourniquet group. Similar total blood loss and blood transfusion rate were observed for both groups. All other parameters revealed no significant differences. CONCLUSIONS Our study suggests that a non-tourniquet TKA would lead to early rehabilitation without increasing side effects. TRIAL REGISTRATION Chinese Clinical Trials Registry, ChiCTR-IOR-16007851 , 1/29/2016.
-
7.
Intravenous combined with topical administration of tranexamic acid in primary total hip arthroplasty: a randomized controlled trial
Zeng Y, Si HB, Shen B, Yang J, Zhou ZK, Kang PD, Pei FX
Orthopaedic Surgery. 2017;9((2):):174-179
Abstract
OBJECTIVE Although there are still some controversies, large previous studies have confirmed that intravenous (i.v.) tranexamic acid (TXA) can effectively reduce blood loss and transfusions in total hip arthroplasty (THA) without increasing the risk of deep venous thrombosis. However, few studies have investigated the combination of i.v. and topical application of TXA in primary THA. The purpose of our current study is to examine whether i.v. combined with topical administration of TXA decreases postoperative blood loss and transfusion rates after THA. METHODS From December 2013 to May 2014, all adult patients undergoing primary THA at our arthroplasty center were considered for inclusion in the present study. Included patients were randomly assigned to two groups by computer-generated list number: a TXA group and a placebo group. Patients in the TXA group received i.v. (15 mg/kg) combined with topical administration (1.0 g) of TXA during the THA procedure, and patients in the other group received the same dosage of normal saline both i.v. and topically. Our primary outcome measures were total blood loss (calculated using Gross's equation), hemoglobin, hematocrit and platelet concentration changes on the third postoperative day, the amount of drainage, the amount of intraoperative blood loss, the frequency of transfusion, and the number of blood units transfused. Secondary outcome measures were the length of postoperative stay, range of hip motion (measured by goniometer), Harris hip scores (HHS), and any perioperative complications or events such as infection, DVT or PE. Range of motion and HHS were measured at 3 week follow-up and compared with preoperative values. RESULTS This trial included 100 patients (50 in each group). Patients in the TXA group had significantly higher postoperative hemoglobin (103 vs 87.7 g/dL, P < 0.01), lower hemoglobin changes (32.2 vs 44.9 g/dL, P < 0.01), higher postoperative hematocrit (0.32 vs 0.27 L/L, P < 0.01), lower hematocrit changes (0.1 vs 0.14 L/L, P < 0.01), lower total blood loss (822 vs 1100 mL, P = 0.004), lower drainage (117.8 vs 242.4 mL, P < 0.01), lower intraoperative blood loss (193.8 vs 288.2 mL, P < 0.01), and lower transfusion rate (2% vs 34%, P < 0.01) compared with those in the placebo group. No statistical difference was found in postoperative platelets between the two groups. There were no differences in perioperative complications or venous thromboembolism (VTE) events. CONCLUSIONS The combined administration of i.v. and topical TXA resulted in a clinically relevant reduction in blood loss, compared with placebo group. No thromboembolic complications were observed. This randomized controlled trial supports the combined i.v. and topical administration of TXA in primary THA.
-
8.
Effect on time of temporarily-closed wound drainage on blood loss of primary total knee arthroplasty after intravenous and intra-articular injection of tranexamic acid
Li R, Yin S, Zhong H, Mu P, Yang J
Chung-Kuo Hsiu Fu Chung Chien Wai Ko Tsa Chih/Chinese Journal of Reparative & Reconstructive Surgery. 31(4):417-421, 2017 Apr 01.. 2017;31((4):):417-421
Abstract
Objective: To investigate the effect and safety of time of temporarily-closed wound drainage on blood loss of primary total knee arthroplasty (TKA) after intravenous and intra-articular injection of tranexamic acid (TXA). Methods: Eighty female patients were selected from 102 patients who underwent primary TKA between September 2015 and July 2016, who were randomly divided into 4 groups: control group (group A), 30 minutes group (group B), 60 minutes group (group C), and 90 minutes group (group D), 20 patients each group. No significant difference was found in age, body mass index, side, pathogen, duration, and preoperative hemoglobin, albumin, and hematocrit between 4 groups ( P>0.05). All the patients received intravenous injection of 1 g TXA at 10 minutes before removing the tourniquet. The patients in group A were injected with 60 mL normal saline into the articular cavity and closed drainage after surgery, while the patients in groups B, C, and D were injected with 60 mL TXA into the articular cavity and closed drainage for 30, 60, and 90 minutes respectively. The volume of drainage at 24 hours after operation, the total blood loss, the postoperative hemoglobin level, maximum hemoglobin loss, albumin loss, the volume and frequency of blood transfusion, venous thrombo embolism rate, and pulmonary embolism rate were recorded and compared between groups. Results: The volume of drainage and total blood loss in groups B, C, and D were less than those of group A, showing significant difference between groups C, D and group A ( P<0.05), but no significant difference between group B and group A ( P>0.05). The volume of drainage at 24 hours after operation in group B was higher than that in groups C and D, showing significant difference between groups B and D ( P<0.05), but no significant difference was found between groups C and D ( P>0.05). There was no significant difference in the total blood loss between groups B, C, and D ( P>0.05). The hemoglobin loss and albumin loss gradually decreased from groups A to D, but no significant difference was found between groups ( P>0.05). No venous thrombo embolism and pulmonary embolism occurred. The hemoglobin value decreased to 28 g/L at 3 days after operation in 1 patient of group D, who received venous transfusion of 20 g human albumin. Conclusion: Intravenous and topical application of TXA in TKA can significantly decrease postoperative bleeding. Topical TXA combined with 60 minutes temporarily-closed wound drainage may reduce postoperative blood loss to the greatest extent without increasing the risk of venous thrombo and pulmonary embolism event after TKA..
-
9.
The efficacy and safety of postoperative retransfusion drain following total hip arthroplasty: a meta-analysis
Xie JW, Xu B, Kang PD, Zhou ZK, Shen B, Yang J, Pei FX
Zhonghua Wai Ke Za Zhi [Chinese Journal of Surgery]. 2016;54((2)):108-13.
Abstract
OBJECTIVE To investigate the effectiveness and safety of post-operative retransfusion drain(PRD) after total hip arthroplasty. METHODS A systematic literature review based on PubMed, EMBase, the Cochrane Library, China Biology Medicine disc, CNKI, VIP and WanFang Database in any language regarding PRD following total hip arthroplasty was performed.The data was evaluated using modified Jadad score and then analyzed using RevMan 5.2. RESULTS Nine randomized controlled trials totaling 1 824 patients, 913 patients in PRD group and 911 in control group, were eligible for data extraction and Meta-analysis.The results indicated that the use of PRD could reduce the requirement of allogeneic blood transfusion when compared with ordinary vacuum drainage (RR=0.61, 95% CI= 0.47-0.79), but the benefit was not found when compared with no drainage group(RR=1.07, 95% CI=0.67-1.71). And the postoperative hemoglobin level was higher in PRD group(MD=0.14, 95% CI=0.01-0.27, P=0.04). No significant difference was identified regarding transfusion index, length of hospital stay, the incidence of febrile reaction and wound-related complications. CONCLUSIONS PRD in reducing requirement of blood transfusion following THA is effective and safe when compared with ordinary vacuum drainage, but the benefit is not found when compared with no drainage.And more robust evidence is needed to confirm this result.
-
10.
Is postoperative cell salvage necessary in total hip or knee replacement? A meta-analysis of randomized controlled trials
Xie J, Feng X, Ma J, Kang P, Shen B, Yang J, Zhou Z, Pei F
International Journal Of Surgery. 2015;21:135-44.
Abstract
OBJECTIVE The purpose of this study was to determine whether there are hematological or clinical differences with the use of postoperative cell salvage after total knee (TKR) and hip replacement (THR). METHODS A systematic literature review based on PubMed, EMBASE, the Cochrane Library Database in any language regarding postoperative cell salvage following TKR or THR was performed. High quality of randomized controlled trials were identified. The data was analyzed using Rev Man 5.2. RESULTS 19 randomized controlled trials (12 in TKR, 4 in THR and 3 in both) about 3482 patients were identified and included in this meta-analysis. Postoperative cell salvage significantly reduced the allogeneic blood transfusion requirement after TKR (RR = 0.46, 95% CI = 0.30 to 0.72) and THR (RR = 0.46, 95%CI = 0.32 to 0.68). It also demonstrated a higher level of postoperative Hemoglobin (MD = 0.26 g/dL, 95%CI = 0.15 to 0.37) with the use of postoperative cell salvage. No significant differences were detected regarding length of hospital stay, the incidence of febrile reaction, wound infection and deep vein thrombosis. CONCLUSION The results strengthen the fact that postoperative cell salvage is effective and safe to reduce the rate of transfusion after TKR and THR. As the relatively poor methodological quality and heterogeneity, further research is needed to confirm its safety and cost-effectiveness.Copyright © 2015 IJS Publishing Group Limited. Published by Elsevier Ltd. All rights reserved.