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

Yıl 2025, Cilt: 18 Sayı: 2, 256 - 269, 01.04.2025

Bahadır Balkanlı , İsmail Tüter , Enver İpek

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

Öz

Amaç: Bu retrospektif çalışmada, genel veya spinal anestezi altında yapılan total diz artroplastisinde lokal traneksamik kullanımının postoperatif kanama üzerine etkisinin karşılaştırması amaçlandı.
Gereç ve yöntem: Bu çalışmada 2017-2023 tarihleri arasında total diz artroplastisi uygulanan primer osteoartritli 95 dizdeki postoperatif kanama miktarları analiz edildi. Genel veya spinal anestezi uygulanan hastalar perioperatif lokal traneksamik asit verilip verilmemesine göre dört gruba ayrıldı. Traneksamik asit uygulaması 1 gr olarak artroplastisi sonrası çevre yumuşak dokulara lokal olarak yapıldı. Çalışmada postoperatif hemogram değişiklikleri, dren miktarları ve transfüzyon ihtiyaçları değerlendirildi.
Bulgular: Grup 4'te, postoperatif ilk 24 saat içinde hemoglobin düzeylerinde anlamlı düzeyde bir düşüş görüldü (p1:0,001; p2:0,000; p3:0,001). Üçüncü gün hemoglobin değerlerinde Grup 1-4 arasında istatistiksel farklılık yoktu (p:0,117). Grup 3'te postoperatif hemoglobin değerleri diğer gruplara göre istatistiksel olarak yüksekti (p1:0,019; p2:0,003). Grup 4'te Grup 1-3'e göre anlamlı derecede yüksek dren hacimleri görüldü (p=0,000). Grup 1'deki drenden gelen miktar istatistiksel olarak anlamlı derecede düşüktü (p1:0,001; p2:0,032). 2 ünite (%6,1) replasman miktarı değerlendirildiğinde, Grup 3'te kan replasman oranları (%6.1) diğer gruplara göre düşüktü (p1:0,002; p2:0,000).
Sonuç: Çalışma, total diz artroplastisinde lokal olarak uygulanan traneksamik asidin postoperatif kanamayı azalttığını, hemoglobin seviyelerini koruduğunu ve drenaj hacimlerini ve transfüzyon gereksinimlerini azalttığını buldu. Potansiyel kanama ile ilişkili komplikasyonları ve maliyetleri azaltmaya katkıda bulunabilir.

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.

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

Öz

Purpose: This retrospective study aimed to compare the effects of local tranexamic use on postoperative bleeding in total knee arthroplasty performed under general or spinal anesthesia.
Materials and methods: This study analyzed the amount of postoperative bleeding in 95 primary osteoarthritis knees that underwent total knee arthroplasty between 2017 and 2023. Patients who underwent general or spinal anesthesia were divided into four groups according to whether or not local tranexamic acid was administered perioperatively. Tranexamic acid was administered locally to the surrounding soft tissues after arthroplasty as 1 g. Postoperative hemogram changes, drain amounts, and transfusion needs were evaluated in the study.
Results: In Group 4, a significant decrease in hemoglobin levels was observed within the first 24 hours postoperatively (p1:0.001; p2:0.000; p3:0.001). There was no statistically significant difference in hemoglobin values on the third day between Groups 1-4 (p:0.117). Postoperative hemoglobin values in Group 3 were statistically higher than the other groups (p1:0.019; p2:0.003). Significantly higher drain volumes were seen in Group 4 compared to Groups 1-3 (p=0.000). The amount coming from the drain in Group 1 was statistically significantly lower (p1:0.001; p2:0.032). When the replacement amount of 2 units (6.1%) was evaluated, blood replacement rates in Group 3 (6.1%) were lower than in the other groups (p1:0.002; p2:0.000).
Discussion: The study found that locally applied tranexamic acid in total knee arthroplasty reduced postoperative bleeding, maintained hemoglobin levels, and reduced drainage volumes and transfusion requirements. It may contribute to reducing potential bleeding-related complications and costs.

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).

Kaynakça

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