Tranexamic acid in total shoulder arthroplasty under regional anesthesia: a randomized, single blinded, controlled trial
Ácido tranexâmico na artroplastia total do ombro sob anestesia regional: um estudo randomizado, simplescego e controlado
Teresa Garcia, Mariana Fragão-Marques, Pedro Pimentão, Martim Pinto, Inês Pedro, Carlos Martins
Abstract
Purpose
The purpose of this study was to determine whether Tranexamic Acid (TXA) can significantly reduce perioperative blood loss in Total Shoulder Arthroplasty (TSA) performed under regional anesthesia.
Methods
We performed a randomized, single blinded, controlled study. Forty-five patients were submitted to TSA under regional anesthesia to treat cuff tear arthropathy, proximal humeral fractures, chronic instability, primary osteoarthrosis, and failures of previous prosthesis. Patients were randomized to either group TXA therapy (TXA), with 1 g Intravenous (IV), or no Intervention (NTXA). Postoperative total drain output, hemoglobin variation, total blood loss, hemoglobin loss, and need for transfusion were measured. Pain-related variables were also assessed: postoperative pain assessment by visual analog scale, inpatient pain breakthrough, quality of recovery, length of stay, and coagulation function testing.
Results
Participants presented a mean age of 76-years, 15.6% were male, 82.2% were American Society of Anesthesiologists (ASA) physical status 1 or 2. There were no differences between groups concerning transfusions, operative time, Post-Anesthesia Care Unit (PACU) length of stay and in-hospital stay, and QoR-15 or postoperative pain. Bleeding measured by drain output at 2, 24 and 48 hours was significantly less in the TXA group at each timepoint. There was a difference in Hb variation – TXA: median (IQR) -1.4 (1.3) g.dL-1 vs. NTXA: -2.2 (1.3) g.dL-1; median difference: 0.80 (0.00–1.20); p = 0.047. aPTT was lower in TXA administered patients – TXA: median (IQR) 29.6 (14.0)s vs. NTXA: 33 (5.8)s; difference in medians: -4.00 (-6.50–-1.00); p = 0.012.
Conclusion
TXA use significantly decreased blood loss measured by drain output and Hb drop in TSA under regional anesthesia.
Keywords
Resumo
Objetivo: O objetivo deste estudo foi determinar se o ácido tranexâmico (TXA) pode reduzir significativamente a perda sanguínea perioperatória na artroplastia total do ombro (TSA) realizada sob anestesia regional. Métodos: Realizamos um estudo randomizado, cego e controlado. Quarenta e cinco pacientes foram submetidos a TSA sob anestesia regional para tratar artropatia de ruptura do manguito, fraturas proximais do úmero, instabilidade crônica, osteoartrose primária e falhas de próteses anteriores. ), ou nenhuma intervenção (NTXA). O débito total do dreno pós-operatório, a variação de hemoglobina, a perda total de sangue, a perda de hemoglobina e a necessidade de transfusão foram medidos. As variáveis relacionadas à dor também foram avaliadas: avaliação da dor pós-operatória por escala visual analógica, avanço da dor do paciente internado, qualidade da recuperação, tempo de internação e teste de função de coagulação. Resultados: Os participantes apresentaram idade média de 76 anos, 15,6% eram do sexo masculino, 82,2% eram estado físico 1 ou 2 da American Society of Anesthesiologists (ASA). Não houve diferenças entre os grupos quanto às transfusões, tempo operatório, tempo na Sala de Recuperação Pós-anestésica (SRPA) de permanência e internamento e QoR-15 ou dor pós-operatória. O sangramento medido pela saída do dreno em 2, 24 e 48 horas foi significativamente menor no grupo TXA em cada ponto de tempo. Houve uma diferença na variação de Hb-TXA: mediana (IQR) -1,4(1,3) g/dL vs NTXA: -2,2 ( 1,3) g/dL; diferença mediana: 0,80 [0,00–1,20]; p=0,047.aPTT foi menor em pacientes administrados com TXA (TXA: mediana (IQR) 29,6 (14,0) s vs.NTXA: 33 (5,8) s; diferença nas medianas: -4,00 [-6,50 - -1,00]; p=0,012 ). Conclusão: O uso de TXA diminuiu significativamente a perda sanguínea medida pelo débito do dreno e queda de Hb na TSA sob anestesia regional.
Palavras-chave
References
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