ABSTRACT
BACKGROUND: Reducing perioperative blood loss in total hip arthroplasty is a hot topic for joint surgeons. Both intravenous infusion and intra-articular injection of tranexamic acid significantly reduce perioperative blood loss, blood transfusion volume, and need for blood transfusion in patients undergoing total hip arthroplasty. However, differences between the intravenous and intra-articular methods are not clear.OBJECTIVE: To evaluate the effects of these two tranexamic acid administration methods on perioperative blood loss in patients undergoing total hip arthroplasty.METHODS: We are conducting a prospective, single-center, open-label, randomized, controlled clinical trial at the Tengzhou Central People's Hospital, China. Ninety patients undergoing unilateral total hip arthroplasty have been randomized into three groups. In the intravenous infusion group (n=30), 15 mg/kg tranexamic acid diluted in 100 mL physiological saline was infused intravenously at the beginning of surgery and 20 mL of physiological saline was injected intra-articularly after deep fascia suturing. In the intra-articular injection group (n=30), 100 mL of physiological saline was infused intravenously at the beginning of surgery and a mixture of 1.5 g tranexamic acid and 20 mL physiological saline was injected intra-articularly after deep fascia suturing. In the control group (n=30), 100 mL of physiological saline was infused intravenously at the beginning of surgery and 20 mL of physiological saline was injected intra-articularly after deep fascia suturing. The primary outcome is hidden blood loss at 1 and 3 days postoperatively. The secondary outcomes are visible blood loss, need for blood transfusion, and mean blood transfusion volume intraoperatively and on days 1 and 3 postoperatively. Other outcomes are the incidence of adverse reactions and complications within 3 months of surgery. The study protocol has been approved by the Ethics Committee of Tengzhou Central People's Hospital of China, approval number 2015-026. All protocols will be performed in accordance with the Ethical Principles for Medical Research Involving Human Subjects in the Declaration of Helsinki. Written informed consent was provided by each patient and their family members after they indicated that they fully understood the treatment plan.DISCUSSION: This trial was designed in April 2015. Cases were collected in July 2015. Data analysis will be finished in December 2017. This study is designed to investigate the effects of intravenous infusion versus intra-articular injection of tranexamic acid on perioperative blood loss in patients undergoing total hip arthroplasty to determine the more effective mode of administration.
ABSTRACT
BACKGROUND:Increasing reports have focused on the application of tranexamic acid to reduce bleeding during total knee arthroplasty, but its usage method remains controversial. OBJECTIVE:To explore the impact of topical articular application of tranexamic acid and intravenous application of tranexamic acid on blood loss during primary unilateral total knee arthroplasty. METHODS:According to randomized control ed principle, 90 patients who received unilateral total knee arthroplasty in the Tengzhou Central People’s Hospital from October 2013 to December 2014 were enrol ed in this study, and randomly assigned to intravenous injection group and topical injection group (n=45). Patients in the intravenous injection group were given tranexamic acid by intravenous injection (10 mg/kg, maximum 1.2 g) during the induction of anaesthesia. Patients in the topical injection group were given intraarticularly tranexamic acid (2 g dissolved in 50 mL physiological saline) before articular capsule suture and after prosthesis fixation. Drainage amount after replacement, hemoglobin and hematocrit on the next day after replacement, and the number of blood transfusion population were compared between the two groups. Simultaneously, clinical symptoms of pulmonary embolism and deep vein thrombosis in the lower limb were observed. If necessary, lower extremity vascular Doppler ultrasound was conducted. RESULTS AND CONCLUSION:No significant differences in drainage amount after replacement, hemoglobin and hematocrit on the next day after replacement, the number of blood transfusion population, and the proportion of blood transfusion were detected between the two groups (P>0.05). No deep vein thrombosis was found in the lower limbs at 14 days after replacement in both groups. These findings confirm that compared with intravenous systemic application, periarticular topical application of tranexamic acid during total knee replacement could obtain identical effects on reducing blood loss and blood transfusion after surgery, and could avoid relevant complications of intravenous application of tranexamic acid.
ABSTRACT
Objective To explore the feasibility of laparoscopy-assisted total mesorectal excision(TME) for anterior resection of rectal cancer.Methods The clinical records of 42 patients with rectal cancer who underwentlaparoscopic TME from April 2006 to July 2008 were analyzed retrospectively.Results All the laparoscopic TME with anal sphincter preservation operations were successful;no case was converted to open procedure.The distal end of rectum was anastomosed by a reusable linear stapler.The average operative time was 195 min(170-230 min) and the operative blood loss 15 mL(10-30 mL).The time for bowel functionrecovery was 32 hours.One patient had postoperative dysuria,and one had intraoperative subcutaneousemphysema.No anastomotic leakage or infection of incisional wound occurred.Conclusions Laparoscopy-assisted anterior resection for rectal cancer is safe and feasible.