Efficacy Assessment of Epidural Blockade and Tranexamic Acid Application in Idiopathic Scoliosis Surgery

The aim of the study was to evaluate the effect of administering tranexamic acid, alone and combined with epidural anesthesia, on postoperative blood loss and donated blood transfusion in patients undergoing corrective scoliosis surgery.

Materials and Methods. 160 patients aged 15–18, were assigned to 4 groups in a double-blinded manner to receive one of the two anesthesia techniques: general anesthesia (sevoflurane and fentanil), or general anesthesia (sevoflurane) with an epidural block (thoracic epidural anesthesia with 0.5% ropivacaine and fentanil) and one of the two solutions for antifibrinolytic therapy. These solutions were tranexamic acid (group GT and group ET), and 0.9% saline as placebo (group GP and group EP). Tranexamic acid was administered in groups ET and GT before skin incision — a bolus of 15 mg/kg followed by IV infusion of 2 mg/kg/h up to the end of surgery. For a statistical analysis, we employed non-parametric methods and linear regression.

Results. Group GT demonstrated a statistically significant reduction in the volume of intraoperative blood loss by 28.9% as compared with group GP. The groups with epidural anesthesia (EP, ET) demonstrated a statistically significant reduction in the volume of intraoperative blood loss by 43.3 and 21.9%, as compared with the groups without the epidural component in anesthesia (GP and GT). The standalone use of tranexamic acid in patients without epidural anesthesia led to a reduction in their intraoperative blood loss by 28.9%. Epidural anesthesia contributed to the limitation of changes in the biochemical data of hemostasis/fibrinolysis system during surgery. At the same time, hypercoagulation changes dominated in group GP. Hence, groups EP and ET did not require hemotransfusion, while group GT featured a much lower need for it. There were no severe complications in all the groups. The effect of fibrinolysis inhibition was complementary.

Conclusion. Tranexamic acid and epidural anesthesia, administered separately or in combination with each other, can be safely and effectively applied to reduce perioperative blood loss and the need for hemotransfusion during corrective surgery for idiopathic scoliosis in adolescents. The combination of the methods produces the biggest blood-saving effect. Still, the standalone use of tranexamic acid in scoliosis surgery is a safe, cheap, and effective method of blood-saving.

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Ezhevskaya А.А., Prusakova Zh.B., Zagrekov V.I., Sosnin A.V., Milenovic M. Efficacy Assessment of Epidural Blockade and Tranexamic Acid Application in Idiopathic Scoliosis Surgery. Sovremennye tehnologii v medicine 2018; 10(4): 164, https://doi.org/10.17691/stm2018.10.4.20