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In patients undergoing total shoulder arthroplasty under
regional anesthesia, tranexamic acid was found to lower blood loss and
hemoglobin drop.
As per the study published in “Brazilian Journal of Anesthesiology”, the usage of tranexamic acid considerably declined blood loss estimated by drain output and hemoglobin drop in total shoulder arthroplasty under regional anesthesia. Investigators undertook this randomized, phase III, single-blinded, controlled study to assess whether tranexamic acid can considerably lower perioperative blood loss in 45 patients undergoing total shoulder arthroplasty carried out under regional anesthesia to treat cuff tear arthropathy, chronic instability, failures of the prior prosthesis, primary osteoarthrosis, and proximal humeral fractures.
Participants (mean age 76 years) were randomly allocated to either (i) Tranexamic acid group (n=23): Subjects were given an intravenous infusion of 1g of tranexamic acid immediately prior to surgery, and (ii) Control group (n = 22): Subjects were offered the same care without the tranexamic acid infusion.
Estimation of post-surgery total drain output, total blood loss, hemoglobin variation and loss, and transfusion requirement were done. Pain-associated variables were also examined: post-surgery pain evaluation by visual analog scale, inpatient pain breakthrough, length of stay, coagulation function testing, and quality of recovery.
No major differences were noted between the groups concerning transfusions, postsurgery pain, operative time, post-anesthesia care unit length of stay and in-hospital stay, and Quality of Recovery 15. Bleeding estimated by drain output at 2, 24, and 48 hours was remarkably diminished in the tranexamic acid arm at each time point, as shown in the below figure:
A difference was noted in the hemoglobin variation between the groups. The activated Partial Thromboplastin Time was found to be reduced in the tranexamic acid recipients, as shown below:
More studies are needed to examine the ideal dose and route
of administration of tranexamic acid in total shoulder arthroplasty and to
evaluate tranexamic acid's effectiveness in alleviating transfusion needs,
concluded the study authors.
Brazilian Journal of Anesthesiology
Tranexamic acid in total shoulder arthroplasty under regional anesthesia: a randomized, single blinded, controlled trial
Teresa Garcia et al.
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