Effect of peroperative local tranexamic acid admistration on bleeding in total knee arthroplasty performed with general or spinal anesthesia

Yıl 2025, Cilt: 18 Sayı: 2, 8 - 8

Bahadır Balkanlı , İsmail Tüter , Enver İpek

https://doi.org/10.31362/patd.1500706

Öz

Purpose: This retrospective study focused on a comparative examination of the effect of local tranexamic use on postoperative bleeding in TKA surgery performed with general or spinal anaesthesia.
Materials and methods: This study analysed the postoperative bleeding amounts in 95 knees with primary osteoarthritis that underwent TKA between January 2017 and 2023. Patients undergoing TKA under general or spinal anaesthesia were separated into four groups based on whether or not local tranexamic acid was given perioperatively. Patients who underwent total knee arthroplasty under general anaesthesia were divided into two groups: group 1 if local tranexamic acid was applied, and group 2 if tranexamic acid was not applied. Patients who underwent total knee arthroplasty under spinal anaesthesia were divided into two groups: group 3 if local tranexamic acid was applied, and group 4 if tranexamic acid was not applied. Tranexamic acid administration was performed locally as 1 g injection into the surrounding soft tissues after knee arthroplasty. The postoperative hemogram alterations, drainage volume, and transfusion needs of these patients were assessed.
Results: Group 4 saw a significantly higher decline in haemoglobin levels within the first twenty-four hours following surgery, distinct from groups 1-3 (p1:0.001; p2:0.000; p3:0.001, p<0.05). There was no notable variance in third-day haemoglobin control values (HG3) between groups 1-4 (p>0.05). Postoperative haemoglobin values in Group 3 were statistically significantly higher than in Groups 1, 2, and 4 (p1:0.019; p2:0.003; p<0.05). Group 4 showed considerably higher drainage values compared to groups 1­3 (p=0.000; p<0.05). The drainage values in group 1 were statistically substantially lower than those in groups 2, 3, and 4 (p1: 0.001; p2: 0.032; p<0.05). When evaluating a replacement threshold of 2 units (6.1%), group 3 had considerably lower blood replacement rates than group 1 (26.7%), group 2 (45.5%), and group 4 (25%) (p1:0.002; p2:0.000; p<0.05).
Discussion: Our study found that administering local tranexamic acid during TKA surgery, whether under general or spinal anaesthesia, has a substantial impact on postoperative bleeding and transfusion requirements. Overall, these findings suggest that local use of TXA during TKA surgery can effectively reduce postoperative bleeding, maintain haemoglobin levels, reduce drainage amounts, and reduce transfusion rates, thus potentially reducing bleeding-related complications and contributing to cost savings.

Anahtar Kelimeler

Tranexamic acid, knee arthroplasty, blood transfusion, anesthesia, surgical drain

Etik Beyan

Permission was received for the study from the Health Sciences University Şişli Hamidiye Etfal Training and Research Hospital SUAM Clinical Research Ethics Committee (13/06/2023 (Permission number 3971).

Genel veya spinal anestezi ile yapılan total diz artroplastisinde peroperatif lokal traneksamik asit uygulamasının kanamaya etkisi

Öz

Amaç: Bu retrospektif çalışma, genel veya spinal anestezi ile yapılan Total diz artroplastisi cerrahisinde lokal traneksamik kullanımının postoperatif kanamaya etkisinin karşılaştırmalı olarak incelenmesine odaklanmıştır.
Gereç ve yöntem: Bu çalışmada Ocak 2017-2023 tarihleri arasında TDA uygulanan primer osteoartritli 95 dizdeki postoperatif kanama miktarları analiz edildi. Genel veya spinal anestezi altında TDA uygulanan hastalar perioperatif olarak lokal traneksamik asit verilip verilmediğine göre dört gruba ayrıldı. Genel anestezi altında total diz artroplastisi yapılan hastalarda lokal traneksamik asit uygulandıysa grup 1, traneksamik asit uygulanmadıysa grup 2 olarak gruplara ayrılmıştır. Spinal anestezi altında total diz artroplastisi yapılan hastalarda lokal traneksamik asit uygulandı ise grup 3, traneksamik asit uygulanmadıysa grup 4 olarak gruplara ayrılmıştırr. Traneksamik asit uygulaması diz artroplastisi uygulandıktan sonra çevre yumuşak dokulara enjeksiyon şeklinde 1 g lokal olarak yapılmıştır. Bu hastaların postoperatif hemogram değişiklikleri, dren miktarı ve transfüzyon miktarları değerlendirildi.
Bulgular: Grup 4'te, grup 1-3'ten farklı olarak ameliyattan sonraki ilk yirmi dört saat içinde hemoglobin düzeylerinde anlamlı düzeyde daha yüksek bir düşüş görüldü (p1:0,001; p2:0,000; p3:0,001, p<0,05). Üçüncü gün hemoglobin kontrol değerlerinde (HG3) grup 1-4 arasında kayda değer bir farklılık yoktu (p>0,05). Grup 3'te ameliyat sonrası hemoglobin değerleri Grup 1,2 ve 4'e göre istatistiksel olarak anlamlı derecede yüksekti (p1:0,019; p2:0,003; p<0,05). Grup 4'te grup 1-3'e göre anlamlı derecede yüksek dren hacimleri görüldü (p=0,000; p<0,05). Grup 1'deki drenden gelen miktarları grup 2-4'e göre istatistiksel olarak anlamlı derecede düşüktü (p1:0,001; p2:0,032; p<0,05). 2 ünite (%6,1) replasman miktarı değerlendirildiğinde, grup 3'te kan replasman oranları grup 1 (%26,7), grup 2 (%45,5) ve grup 4'e (%25) göre oldukça düşüktü (p1:0,002; p2: 0,000; p<0,05).
Tartışma: Çalışma, ister genel ister spinal anestezi altında olsun, TDA ameliyatı sırasında lokal traneksamik asit uygulamasının postoperatif kanama ve transfüzyon gereksinimleri üzerinde önemli bir etkiye sahip olduğunu buldu. Genel olarak bu bulgular, TDA ameliyatı sırasında traneksamik asitin lokal kullanımının postoperatif kanamayı etkili bir şekilde azaltabileceğini, hemoglobin düzeylerini koruyabileceğini, dren miktarlarını azaltabileceğini ve transfüzyon oranlarını azaltabileceğini, dolayısıyla potansiyel olarak kanamayla ilişkili komplikasyonları azaltabileceğini ve maliyetlerin azalmasına katkıda bulunabileceğini göstermektedir.

Anahtar Kelimeler

Traneksamik asit, diz artroplastisi, kan transfüzyonu, anestezi, cerrahi dren

Etik Beyan

Araştırma için Sağlık Bilimleri Üniversitesi Şişli Hamidiye Etfal Eğitim ve Araştırma Hastanesi SUAM Klinik Araştırmalar Etik Kurulu'ndan 13/06/2023 (İzin numarası 3971) izin alındı.

Kaynakça

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