Comparison of blood loss in total knee replacement surgery with and without tranexamic acid: a prospective, time framed and observational analytical study

Background: Total knee replacement is one of the common orthopaedic procedures performed worldwide. Blood transfusion is one of the major requirements in TKR procedure due to the amount of blood loss during and after the procedure. We carried out a prospective study to determine the efficacy of tranexamic acid in controlling blood loss during TKR procedure. Methods: Study was conducted at a tertiary care centre, involving cases operated by a single surgeon. Study included 140 patients undergoing primary TKR for advance degenerative disease of knee and were divided into two groups of 70 each, one group that received tranexamic acid before surgery and another group that did not receive tranexamic acid before surgery. Patient with allergy to the drug, hepato/renal dysfunction, DVT, abnormal PT and INR were not included. Tranexamic acid was given intravenously as well as intra-articular. Results: Pre-operative haemoglobin ranged from 10.2 gm% to 14.4 gm% in the group getting tranexamic acid and from 10% to 14 % in the group not getting tranexamic acid. Post operatively haemoglobin varied from 8.4 gm% to 12.8 gm% in Group 1 and from 7.8 gm% to 12 gm% in Group 2. Difference of mean post-operative Hb (p=0.0045) and PCV (p=0.0024) in two groups was statistically significant. Conclusions: We concluded that administration of tranexamic acid reduces the blood loss as well as need of blood transfusion in a patient undergoing total knee replacement.

Use of Panicker’s cannula in management of atonic postpartum hemorrhage

Postpartum hemorrhage (PPH) is leading cause of maternal mortality worldwide. Panicker’s cannula creates negative pressure inside the uterus that causes shrinking of the uterus which can assist the physiological process of contraction and retraction to stop atonic postpartum hemorrhage. It is safe and simple technique to prevent and treat PPH. It can be used in low-resource and primary care settings, where even para medical personnel can use this method effectively to prevent morbidity and mortality. This can also be used in non-PPH conditions. In this study total 20 women with singleton pregnancy (14 had vaginal delivery and 6 underwent cesarean section), who developed atonic postpartum hemorrhage were included in the study. Panicker’s cannula was used in the patients, in whom bleeding was not stopped despite using uterotonics. Cessation of complete bleeding was observed in all 20 women within 4 minutes, which was associated with contraction and firm retraction of the uterus. Amount of the blood in bottle ranged from 150-250 ml. Vacuum retraction of uterus assists in the normal physiological process of contraction and retraction. This simple and cost effective technique, takes very little time to stop bleeding. This lifesaving technique is useful in all settings especially in low resource settings.

Clinical efficacy analysis of interventional treatment of iatrogenic massive vaginal bleeding / 实用放射学杂志

Objective To investigate the clinical efficacy and value of interventional treatment of iatrogenic massive vaginal bleed-ing.Methods Retrospective analysis was performed on 35 patients with postoperative vaginal massive hemorrhage in obstetrics and gynecology who were admitted.Abdominal aorta and bilateral internal iliac arteries angiography and embolization of abnormal vessels were performed under digital subtraction angiography(DS A),and relevant clinical data were recorded and analyzed.Results After interventional treatment,the vaginal bleeding of 33 patients basically stopped within 3 days,and the average interventional operation time was(57.5±17.2)min.The hemoglobin value,hematocrit and blood pressure decreased and the heart rate increased significantly before and after interventional embolization in obstetrics and gynecology,with statistical significance(P＜0.05).There were no sig-nificant changes in hemoglobin value and hematocrit between the completion of interventional embolization and 72 hours after interventional embolization(P＞0.05).The increase of blood pressure and the decrease of heart rate were statistically significant(P＜0.05).Two patients with cesarean section had poor hemostatic effect after interventional embolization,and the bleeding stopped after exploratory laparotomy and hysterectomy.Conclusion Interventional treatment has the advantages of small trauma,simple operation,signifi-cant curative effect,few adverse reactions,and rapid recovery.It plays an important role and clinical value in the diagnosis and treat-ment of iatrogenic vaginal bleeding.

Effect of diabetes mellitus on perioperative blood loss and pain after primary total knee arthroplasty / 中国组织工程研究

BACKGROUND:Total knee arthroplasty is the main therapeutic regimen for end-stage osteoarthritis.However,diabetes mellitus can affect the treatment effect and prognosis. OBJECTIVE:To explore the effect of diabetes mellitus on perioperative blood loss and postoperative pain in patients undergoing primary total knee arthroplasty. METHODS:A retrospective study was conducted on 154 patients who underwent primary total knee arthroplasty and met the inclusion criteria in the Osteonecrosis and Joint Reconstruction Ward of Xi'an Honghui Hospital Affiliated to Xi'an Jiaotong University from January to April 2021.Patients were divided into a non-diabetic group and a diabetic group according to their diagnosis,with 32 cases in the diabetic group,9 males and 23 females,aged 55 to 80(66.58±7.16)years and 122 cases in the non-diabetic group,34 males and 88 females,aged 44 to 83(66.69±6.63)years.Perioperative blood loss(including total blood loss,hidden blood loss,the falling value of hemoglobin and hematocrit)was calculated for both groups.Visual analog scale scores,hospital for special surgery knee score,and Caprini scores were recorded preoperatively and postoperatively. RESULTS AND CONCLUSION:(1)Total blood loss was significantly lower in the non-diabetic group(729.93±233.83 mL)than that in the diabetic group(853.69±184.91 mL)(P<0.05).Latent hidden blood loss was also significantly lower in the non-diabetic group(624.40±233.19 mL)than that in the diabetic group(749.08±179.49 mL)(P<0.05).(2)In the non-diabetic group,the visual analog scale scores preoperatively and 1 month postoperatively were significantly lower than those in the diabetic group(P<0.05).The differences in visual analog scale scores at 3 days and 3 months postoperatively between the non-diabetic group and the diabetic group were not statistically significant(P>0.05).(3)The hospital for special surgery knee score at 1 month postoperatively was significantly higher in the non-diabetic group than that in the diabetic group(P<0.05).There was no significant difference in hospital for special surgery knee score between the two groups at 3 months postoperatively(P>0.05).(4)There was no statistically significant difference in preoperative and postoperative Caprini scores between the two groups(P>0.05).(5)It is concluded that having diabetes increases total and occult hidden blood loss in primary total knee arthroplasty.In the short term after total knee arthroplasty,diabetes increases the patient's pain and affects the recovery of joint function,but the negative effects fade with time.

Efficacy and safety of different applications of tranexamic acid in high tibial osteotomy / 中国组织工程研究

BACKGROUND:High tibial osteotomy results in massive blood loss during the perioperative period.Tranexamic acid can effectively reduce perioperative blood loss.However,the method of tranexamic acid application has not been unified. OBJECTIVE:To investigate the effect and safety of different methods of tranexamic acid on perioperative blood loss in the high tibial osteotomy. METHODS:A total of 160 patients who underwent primary unilateral high tibial osteotomy in the Binzhou Medical University Hospital from January 2019 to December 2021,including 69 males and 91 females,were randomly divided into four groups(n=40 per group).Among them,40 patients were given an intravenous infusion of saline containing 2 g tranexamic acid 10 minutes before tourniquet release(venous group);40 patients were given an intravenous infusion of 1 g tranexamic acid and 1 g tranexamic acid was injected through a drainage tube after the closure of the incision(combined group);40 patients were given 2 g tranexamic acid infusion into drainage tube after the closure of the incision(perfusion group);an additional 40 patients were given an intravenous infusion of the same amount of normal saline(blank group).The general information was compared among the four groups of patients.The hemoglobin,hematocrit,intraoperative blood loss,drainage volume,blood transfusion rate,incision complication,and the incidence of deep vein thrombosis were recorded on days 1,3 and 5 after operation in the four groups.The total blood loss and hidden blood loss were calculated. RESULTS AND CONCLUSION:(1)There was no statistically significant difference in general information among the four groups.(2)No significant difference was found in intraoperative blood loss among the four groups.(3)The maximum decreased values of hemoglobin and hematocrit on days 1,3 and 5 after operation,drainage volume,total blood loss and hidden blood loss were all ranked as the combined group<venous group<perfusion group<blank group.(4)The postoperative blood transfusion rate of the blank group was significantly higher than that of the other three groups,and there was no significant difference in the postoperative blood transfusion rate among the combined group,the venous group and the perfusion group.(5)There was no significant difference in the incidence of venous thrombosis and incision complications among the four groups.(6)It is indicated that the application of tranexamic acid in high tibial osteotomy can reduce perioperative bleeding and postoperative blood transfusion rate,and the effect of intravenous infusion combined with drainage tube perfusion is better,which does not increase the incidence of venous thrombosis and incision complications.

Effect analysis of a modified topical application of tranexamic acid in primary total knee arthroplasty / 中国组织工程研究

BACKGROUND:In recent years,tranexamic acid has been extensively used to mitigate the substantial blood loss associated with total knee arthroplasty.However,the optimal method of topical application has not yet been established. OBJECTIVE:To evaluate the effectiveness and safety of intraoperative topical application of tranexamic acid combined with physical compression dressing in reducing perioperative blood loss in total knee arthroplasty. METHODS:A retrospective analysis was conducted on 90 patients who underwent total knee arthroplasty at the Honghui Hospital in Xi'an from January 2021 to December 2022.Based on the different topical use methods of tranexamic acid during surgery,patients were divided into three groups,with 30 cases in each group.In the compression dressing group,2 g of tranexamic acid was placed in the articular cavity,and after packing the wound with gauze and cotton pads,a bandage was used to compress the wound.In the periarticular injection group,2 g of tranexamic acid was injected into the surrounding tissue of the articular cavity.In the intra-articular injection group,2 g of tranexamic acid was injected into the articular cavity.The blood loss,operation time,coagulation indicators,inflammatory indicators,and postoperative complications of the three groups were statistically analyzed. RESULTS AND CONCLUSION:(1)In terms of total blood loss,hidden blood loss,and maximum hemoglobin drop,the periarticular injection group had the least amount,and there was no statistically significant difference between the compression dressing group and periarticular injection group(P>0.05).In terms of intraoperative blood loss,the compression dressing group had the least amount,and there were statistically significant differences compared with the periarticular injection group and intra-articular injection group(P<0.05).There was no statistically significant difference in operation time among the three groups(P>0.05).(2)There were no statistically significant differences in coagulation indicators(D-dimer and fibrinogen degradation products)and inflammation indicators(C-reactive protein and erythrocyte sedimentation rate)among the three groups preoperatively and on the first and third days after operation(P>0.05).(3)There was no statistically significant difference observed among the three groups in terms of slow blood flow in the affected limb,intramuscular venous thrombosis,soft tissue swelling,and incidence of wound complications(P>0.05).Additionally,no cases of deep vein thrombosis or pulmonary embolism were detected in any of the groups.(4)The topical application of tranexamic acid combined with compression dressing achieves the same effect as a periarticular injection in terms of simplicity of operation and reduced perioperative blood loss.This method also avoids the trauma caused by repeated punctures and does not increase the incidence of postoperative complications,making it a worthwhile option for clinical promotion.

Effects of intravenous and topical tranexamic acid on blood loss and inflammatory response after posterior cervical decompressive laminectomy / 中国组织工程研究

BACKGROUND:With the increase of the incidence of cervical spondylosis,it is particularly important to control the postoperative bleeding and related inflammatory reaction of cervical vertebra. OBJECTIVE:A prospective study was conducted to investigate the combined effect of intravenous and topical tranexamic acid of different concentrations on postoperative blood loss and inflammatory response during posterior cervical decompressive laminectomy combined with lateral mass screw internal fixation and bone graft fusion. METHODS:From January 2020 to December 2022,150 patients who were scheduled to undergo posterior cervical decompressive laminectomy combined with lateral mass screw internal fixation and bone graft fusion for cervical spondylotic myelopathy in Tianjin People's Hospital were enrolled in the study.Patients were divided into A,B,and C groups(n=50)by randomized double-blind lottery.The patients in the A,B,and C groups were treated with 1%,3%,and 5%intravenous and topical tranexamic acid solution,respectively.Postoperative blood loss and inflammation-related indicators were compared among three groups.The occurrence of venous thromboembolism and hematoma was observed after operation. RESULTS AND CONCLUSION:(1)There were significant differences in blood loss-related indexes,such as intraoperative blood loss,overall blood loss,and occult blood loss among the three groups(P<0.01).The above indexes were significantly lower in groups B and C than that in group A.There was no significant difference between groups B and C(P>0.05).(2)On days 1 and 3 after surgery,the levels of inflammatory indicators including serum C-reactive protein and interleukin-6 were increased to varying degrees in the three groups compared to before surgery(P<0.05).As the drug concentration increased,its expression decreased,and there was a significant difference among the three groups(P<0.001).(3)Two cases of intramuscular venous thrombosis appeared in each of the three groups after surgery.No hematoma or pulmonary embolism occurred in all three groups.(4)It is concluded that in posterior cervical decompressive laminectomy combined with lateral mass screw internal fixation and bone graft fusion,intravenous combined with topical application of different concentrations of tranexamic acid is effective in reducing perioperative blood loss and inflammatory response.3%tranexamic acid achieves the same effect without significantly increasing the risk of postoperative venous thromboembolism.

Prolonging use of tranexamic acid is helpful to reduce perioperative hidden blood loss in senile patients with intertrochanteric fractures / 中国组织工程研究

BACKGROUND:Intertrochanteric fracture of femur often occurs in the elderly,and there will be a large amount of hidden blood loss after surgery.Reducing hidden blood loss can decrease complications and hospital stay. OBJECTIVE:To evaluate the effect of prolonged use of tranexamic acid on hidden blood loss after proximal femoral nail antirotation implantation in senile intertrochanteric fractures. METHODS:From January 2022 to May 2023,62 elderly admitted patients with intertrochanteric fracture of femur were selected from Zigong Fourth People's Hospital.All of them were treated with proximal femoral nail antirotation implantation after closed reduction on the traction bed.According to the use time of tranexamic acid,they were divided into two groups.In the control group(n=38),1 g tranexamic acid was given intravenically 15-30 minutes before incision,and 1 g was added 3 hours later.Based on the control group,the trial group(n=24)was given 1 g tranexamic acid intravenously once for 12 hours on the first day after surgery.Blood routine examinations were performed before surgery,on the day after surgery,and on the first,third and fifth days after surgery.Hemoglobin and hematocrit were counted.The theoretical total blood loss was calculated by Cross equation,and the incidence of complications in the two groups was recorded. RESULTS AND CONCLUSION:(1)Through statistical analysis,there was no significant difference in the amount of dominant blood loss between the two groups(P>0.05).(2)The number of grams of hemoglobin decreased,total blood loss and hidden blood loss in the trial group during perioperative period were lower than those in the control group,and the differences were statistically significant(P<0.05).(3)The hemoglobin values of the trial group on day 3 after surgery,and the hematocrit values on days 1 and 3 after surgery were higher than those of the control group,with statistical significance(P<0.05).(4)The hemoglobin and platelet count showed a downward trend after surgery,and the hemoglobin value was the lowest value on day 3,and the platelet value was the lowest value on day 1 after surgery,and then began to rise in both groups.(5)There was no significant difference in postoperative complications between the two groups(P>0.05).(6)The results show that prolonging use of tranatemic acid can effectively reduce the hidden blood loss in the treatment of femoral intertrochanteric fracture with proximal anti-rotation intramedullary nail,and does not increase the risk of complications.

Digital medical 3D technology versus traditional 2D technology in the diagnosis and treatment of solid abdominal tumors in children / 中国基层医药

Objective:To investigate the value of digital medical 3D technology versus traditional 2D technology in the diagnosis and treatment of solid abdominal tumors in children. Methods:A total of 80 children with solid abdominal tumors who received surgical treatment guided by digital medical 3D technology at Guigang People's Hospital from January 2018 to January 2022 were included in the observation group. An additional 80 children with solid abdominal tumors who received surgical treatment guided by traditional 2D technology at the same hospital from January 2014 to December 2017 were included in the control group. Clinical efficacy was compared between the two groups.Results:The surgical time, intraoperative blood loss, postoperative exhaust time, postoperative hospital stay in the observation group were (111.8 ± 28.9) minutes, (26.8 ± 25.2) mL, (2.2 ± 1.2) days, (7.5 ± 1.4) days, respectively, which were significantly shorter or less than those in the control group [(193.1 ± 66.0) minutes, (86.2 ± 47.0) mL, (3.7 ± 0.9) days, (12.2 ± 3.5) days, t = 7.00, 6.88, 5.87, 7.53, all P < 0.05]. The complete surgical resection rate in the observation group was significantly higher than that in the control group [92.5% (74/80) vs. 81.3% (65/80), χ2 = 4.44, P < 0.05]. The incidence of complications in the observation group was significantly lower than that in the control group [6.3% (5/80) vs. 16.3% (13/80), χ2 = 4.00, P < 0.05]. Conclusion:The utilization of digital medical 3D technology in the surgical treatment of solid abdominal tumors in children can markedly decrease surgical time, reduce intraoperative blood loss, promote postoperative recovery, achieve a high surgical resection rate, and minimize postoperative complications.

Use of tranexamic acid in corrective surgery for adolescent idiopathic scoliosis:effectiveness and safety / 中国脊柱脊髓杂志

Objectives:To assess the efficacy and safety of intravenous use of tranexamic acid(TXA)in re-ducing blood loss during correction surgery for patients with adolescent idiopathic scoliosis(AIS).Methods:The clinical data of 759 AIS patients who underwent posterior corrective fusion surgery at Nanjing Drum Tower Hospital between November 2016 and May 2022 were reviewed retrospectively.There were 544 females and 215 males,with an average age of 14.7±2.1 years.Among the patients,369 patients receiving intra-venous use of TXA during surgery were included in the TXA group,while the other 390 patients receiving the same volume of saline but not TXA were included in the control group.The baseline data(age,gender ratio,Cobb angle,and scoliosis type),pre-and postoperative blood laboratory parameters[hemoglobin(Hb),hematocrit(Hct),platelet count(PLT),prothrombin time(PT),D-dimer,activated partial thromboplastin time(APTT),and fibrinogen(FIB)],blood management indicators(intraoperative blood loss,intraoperative blood trans-fusion,postoperative drainage volume and removal time of drainage tube),and correction-related indicators(pre-and postoperative scoliosis degree,correction rate)and postoperative complications were compared be-tween the two groups.Results:There were no significant differences in baseline data and preoperative blood laboratory parameters between the groups(P>0.05).In TXA group,the intraoperative blood loss(551.7±130.3mL),intraoperative blood transfusion volume(551.3±96.3mL),postoperative drainage volume(468.3±162.5mL),and postoperative drainage time(2.8±0.4d)were all significantly lower than those in the control group(666.7±166.8mL,650.0±138.3mL,550.0±135.1mL,3.1±0.8d,P<0.05).Postoperative D-dimer and PLT in the TXA group were significantly lower than those in the control group(P<0.05),while other blood laboratory parameters showed no significant differences between the two groups(P>0.05).There were no statistically significant differ-ences in scoliosis correction rates,postoperative complication rates between the two groups(P>0.05).Conclusions:The use of TXA in surgery can reduce the perioperative blood loss and transfusion,and improve coagulation status in AIS patients,without increasing the incidence rates of complications.

Effect of adding tranexamic acid during surgery on blood loss and security during short segment lumbar spinal stenosis surgery / 中国输血杂志

【Objective】 To discuss the effect of adding tranexamic acid(TXA) during surgery on blood loss and security during short segment lumbar spinal stenosis surgery. 【Methods】 One hundred and eight patients with lumbar spinal stenosis who were to undergo lumbar posterior fusion surgery were randomly divided into control group, TXA group and adding TXA group, with 36 patients in each group. In the control group, TXA was not used during surgery.The TXA group received intravenous infusion of 100 mL normal saline mixture containing 1 g of TXA 15 minutes before surgery after anesthesia. In adding TXA group, after the same operation in TXA group, 10 mg/kg(body weight) of TXA was infused 3 hours later. Total perioperative blood loss, dominant blood loss, hidden blood loss, intraoperative blood loss, postoperative drainage volume, and transfusion rate were recorded in the two groups. Hemoglobin (Hb), hematocrit(HCT), prothrombin time international standardized ratio (PT-INR), prothrombin time(PT), activated partial thromboplastin time(APTT), blood platelet count (BPC), D-dimer (D-D), fibringen(FIB), C-reactive protein (CRP), alanine aminotransferase (ALT), blood urea nitrogen (BUN) were measured 3 days before and after the surgery in the three groups. Postoperative adverse events were followed up. 【Results】 The total blood loss(mL) [(968.7±209.6) vs (1 369.8±276.3), (968.7±209.6) vs (1 273.9±250.2)], dominant blood loss(mL) [(590.5±164.3) vs (876.4±235.9), (590.5±164.3) vs (789.3±221.7)], intraoperative blood loss(mL) [(318.7±120.7) vs (457.8±146.6), (318.7±120.7) vs (423.9±162.3)] and postoperative drainage volume(mL) [1 day after surgery: (164.6±25.0) vs (262.3±51.7), (164.6±25.0) vs (219.8±37.1); 3 days after surgery: (107.2±18.6) vs (156.3±37.6), (107.2±18.6) vs (145.3±22.3)] of the adding TXA group were lower than those of the control group and TXA group (P0.05). Compared with the preoperative results, Hb, Hct and BPC in the three groups decreased (P0.05), and all of them were within the normal range. No serious adverse events such as deep vein thrombosis, pulmonary embolism, epilepsy, liver and kidney damage were found in all patients after postoperative follow-up. 【Conclusion】 Intraoperative addition of TXA can effectively reduce the amount of blood lost during short segment lumbar spinal stenosis surgery without increasing the risk of complications such as coagulation disorders, thrombosis, liver and kidney function damage.

Bundle para quantificação de perda sanguínea pós-parto vaginal / Bundle para la cuantificación de pérdida sanguínea posparto vaginal / Bundle for quantifying vaginal blood loss after childbirth

Resumo Objetivo Construir e validar o conteúdo de um bundle para quantificação da perda sanguínea pós-parto vaginal. Métodos Estudo metodológico desenvolvido de fevereiro a agosto de 2022, em três etapas: levantamento bibliográfico, construção do instrumento e validação de conteúdo por 14 experts. O instrumento para validação foi composto por 11 itens selecionados a partir de revisão sistemática. Para cada item do bundle aplicou-se escala Likert e para verificar a concordância entre experts, calculou-se o Índice de Concordância. Consideraram-se válidos os itens com concordância acima de 80%. A validação de conteúdo foi realizada em uma única rodada de avaliação. Resultados A versão final do bundle foi composta por nove itens. Os cuidados propostos estão relacionados à quantificação direta do sangramento pós-parto e seu registro, observação da puérpera, a utilização de protocolos institucionais em casos de hemorragia pós-parto, assim como a capacitação da equipe. Conclusão O estudo permitiu construir e validar bundle para quantificação da perda sanguínea pós-parto vaginal, com vistas à melhora do diagnóstico de hemorragia pós-parto.

Resumen Objetivo Elaborar y validar el contenido de un bundle para la cuantificación de pérdida sanguínea posparto vaginal. Métodos Estudio metodológico, llevado a cabo de febrero a agosto de 2022, en tres etapas: análisis bibliográfico, construcción del instrumento y validación de contenido por 14 expertos. El instrumento para validación consistió en 11 ítems seleccionados a partir de revisión sistemática. Se aplicó la escala Likert para cada ítem del bundle; y para verificar la concordancia entre expertos, se calculó el Índice de Concordancia. Se consideraron válidos los ítems con concordancia superior a 80 %. La validación de contenido se realizó en una única ronda de evaluación. Resultados La versión final del bundle consistió en nueve ítems. Los cuidados propuestos están relacionados con la cuantificación directa del sangrado posparto y su registro, la observación de la puérpera, la utilización de protocolos institucionales en casos de hemorragia posparto, así como también la capacitación del equipo. Conclusión El estudio permitió elaborar y validar un bundle para la cuantificación de pérdida sanguínea posparto vaginal, con el fin de mejorar el diagnóstico de hemorragia posparto.

Abstract Objective To construct and validate the content of a bundle to quantify vaginal blood loss after childbirth. Methods This is a methodological study developed from February to August 2022, divided into bibliographic survey, instrument construction and content validity, by 14 experts. The instrument for validity consisted of 11 items selected from a systematic review. For each item in the bundle, a Likert scale was applied, and to check agreement among experts, the Concordance Index was calculated. Items with agreement above 80% were considered valid. Content validity was carried out in a single round of assessment. Results The final version of the bundle consisted of nine items. The proposed care is related to direct quantification of postpartum bleeding and its recording, observation of postpartum women, use of institutional protocols in cases of postpartum hemorrhage as well as team training. Conclusion The study allowed constructing and validating a bundle for quantifying vaginal blood loss after childbirth, with a view to improving postpartum hemorrhage diagnosis.

Adequacy of traditional curette versus powered shaver for adenoid clearance: a comparative study

Background: Adenoid growth is a prevalent aetiology of blockage of nasal passage in paediatric patients, and multiple techniques exist for their surgical removal. The objective of this investigation was to study the efficacy of the conventional curette versus the endoscopic guided powered shaver in the context of adenoid clearance.Methods: In this study, a comparative analysis was performed on a sample of 119 patients, consisting of two distinct groups. Group I-60 patients who underwent conventional adenoidectomy, while group II-59 patients who underwent endoscopic microdebrider-assisted adenoidectomy. The methods employed in this study were in accordance with established medical practises. The research evaluated outcome measures including surgical duration, haemorrhage, and perioperative and postoperative adverse events.Results: Group I, 17 (28.3%) received adenoidectomy as a standalone procedure, group II, 22 (37.3%) received adenoidectomy as a standalone procedure. An adenotonsillectomy was executed on 21 patients, accounting for 35% of group I, and 10 patients, accounting for 16.9% of group II. The study found that group I exhibited significantly reduced operation time and blood loss compared to group II (20.88�41 vs. 29.00�15 minutes and 13.47�02 vs. 18.64�16 millilitres, respectively). Intraoperative complications were observed in 10% of patients in group I and 5.1% of patients in group II. The group II participants exhibited a more rapid onset of symptomatic relief compared to those in group I. There was no evidence of recurrence in the cohort of patients who underwent endoscopic microdebrider-assisted adenoidectomy.Conclusions: Endoscopic microdebrider-assisted adenoidectomy is a superior and dependable technique compared to curettage, exhibiting improved clearance rates and patient contentment.

A re-look into intra-operative impediments and post-operative morbidities in repeat caesarean section

Background: Repeat caesarean sections are known to be a cause of significant morbidity in both intra and post-operative period. The challenges faced by the surgeon may include adhesions, difficulty in delivery of foetus, visceral injury and bleeding. The post-operative recovery may be marred by problems such as post-partum haemorrhage, febrile morbidity, wound infections and the after effects of intra-operative visceral injury. It is these issues that often make repeat caesarean section a cause for concern and delay the recovery of the mother.Methods: At random, hundred ante-natal patients visiting the obstetric OPD, meeting the inclusion criteria of previous caesarean section and planned for repeat caesarean section were selected and all the data were collected and tabulated.Results: After careful analysis of the data, it is observed that the intra-operative findings of adhesions, placenta praevia and excessive blood loss were encountered in relook caesarean sections. Similarly post operative morbidity in the form of wound infection and fever were observed in the same study population.Conclusions: If we are more vigilant and restrict the number of primary caesarean sections to evidence based appropriate indications, we may be successful in reducing the number of repeat caesarean sections and thereby mitigating the subsequent hardships for the mother.

A re-look into intra-operative impediments and post-operative morbidities in repeat caesarean section

Background: Repeat caesarean sections are known to be a cause of significant morbidity in both intra and post-operative period. The challenges faced by the surgeon may include adhesions, difficulty in delivery of foetus, visceral injury and bleeding. The post-operative recovery may be marred by problems such as post-partum haemorrhage, febrile morbidity, wound infections and the after effects of intra-operative visceral injury. It is these issues that often make repeat caesarean section a cause for concern and delay the recovery of the mother.Methods: At random, hundred ante-natal patients visiting the obstetric OPD, meeting the inclusion criteria of previous caesarean section and planned for repeat caesarean section were selected and all the data were collected and tabulated.Results: After careful analysis of the data, it is observed that the intra-operative findings of adhesions, placenta praevia and excessive blood loss were encountered in relook caesarean sections. Similarly post operative morbidity in the form of wound infection and fever were observed in the same study population.Conclusions: If we are more vigilant and restrict the number of primary caesarean sections to evidence based appropriate indications, we may be successful in reducing the number of repeat caesarean sections and thereby mitigating the subsequent hardships for the mother.

Evolución de la pérdida sanguínea en la prótesis total de rodilla con recuperador de sangre vs drenaje convencional / Evolution of blood loss in total knee prosthesis with blood recovery system vs conventional drainage

Resumen: Introducción: la cirugía protésica total de rodilla (PTR) se puede asociar a pérdidas sanguíneas (PS) significativas. El objetivo es analizar la evolución de la PS tras PTR con recuperador sanguíneo vs drenaje convencional. Material y métodos: estudio prospectivo de dos grupos de 30 pacientes intervenidos de PTR, uno control (GC) y otro estudio con recuperador (GR). Se analizó la PS, hematocrito (Hcto), hemoglobina (Hb), tensión arterial sistólica (TAS) y diastólica (TAD) y frecuencia cardíaca (FC) a las tres, 24, 48, 72 y 96 horas postquirúrgicas, la necesidad de transfusión, el porcentaje de altas en 72 horas y las complicaciones. Resultados: la mayor PS y porcentaje de cambio de Hcto y Hb se produjo a las tres horas postquirúrgicas e inició su recuperación a las 72 horas en el GR (Hcto, p = 0.02) (Hb, p = 0.04) y a las 96 horas en el GC. La TAS, TAD y FC empezó su recuperación a las 72 horas en ambos grupos. El descenso de TAS fue mayor en el GC a las tres horas (p = 0.02), 24 horas (p = 0.02) y 48 horas (p = 0.01) postquirúrgicas. Veinte y 33% de los pacientes fueron transfundidos, además 20 y 74% fueron dados de alta a las 72 horas en el GC y GR, respectivamente. Conclusión: la mayor PS y porcentaje de cambio de Hcto y Hb se produce a las tres horas postquirúrgicas y empieza su recuperación a las 72-96 horas. El recuperador favorece la recuperación del Hcto, Hb y TAS, disminuye la necesidad de transfusión y favorece el alta precoz.

Abstract: Introduction: knee prosthetic surgery can be associated with significant blood loss that can account for up to 20% of blood volume. The objective of our study is to analyze blood loss (BL) after total knee replacement (TKR), with the use of a blood recovery system vs a normal drain. Material and methods: prospective, comparative, and observational study of two groups of 30 patients who underwent TKR, one control (CG) and another study group with a recovery system (RG). We analyzed PS, hemoglobin (Hb), hematocrit (Htc), systolic blood pressure (SBP) and diastolic blood pressure (DBP) and heart rate (HR) at 3-, 24-, 48-, 72- and 96-hours post-surgery, the need for transfusion, and the percentage of discharges in 72 hours and complications. Results: the highest percentage of change in Htc and Hb occurred in the first 3 hours post-surgery and recovery began at 72 hours in the RG (p = 0.02) and at 96 hours in the CG (p = 0.04). The decrease in Hb and Htc began his recovery at 72 hours in the RG and at 96 hours in the CG. The TAS, TAD and FC began their recovery at 72 hours in both groups. The decrease in SBP was greater in the CG at 3 hours (p = 0.02), 24 hours (p = 0.02) and 48 hours (p = 0.01) post-surgery. Six patients were transfused in RG and 10 in CG (p = 0.22). 20% and 74% of the patients were discharged at 72 hours in the CG and RG, respectively. Conclusion: the greatest BL occurs in the first 3 hours post-surgery and recovery begins at 72-96 hours. Recovery blood system decreases BL during the first 3 hours, enhance the recuperation of Hb and SBP, decreases the need for transfusion and favors early discharge.

Effect of intravenous tranexamic acid in reducing blood loss during and after caesarean section: a quasi-experimental study in RIMS, Manipur

Background: PPH is the most common cause of maternal death worldwide. Risk factors for PPH include grand multiparity and multiple gestation. However, PPH may occur in women without identifiable clinical or historical risk factors. It is therefore recommended that active management of the third stage of labour be offered to all women during childbirth, whenever a skilled provider is assisting with the delivery. The aim of our study is to determine the efficacy of tranexamic acid in decreasing blood loss in elective LSCS.Materials: A quasi experimental study was done in 312 pregnant women undergoing elective LSCS in the Department of Obstetrics and Gynaecology, at a tertiary health teaching centre RIMS, Imphal, Manipur from September 2019 to November 2021. Ethical clearance was obtained from Research ethics Board to carry out the study. Data were entered in IBM SPSS version 21 software for Windows.Results: The total of 312 pregnant women were included in the study. Most of the pregnant women were in the age group of 27 years. In our study, there was a significant decrease in intraoperative and postoperative blood loss in women receiving tranexamic acid. There was significant fall in post-operative haemoglobin in control group as compared to study group. Also, women who received tranexamic acid did not develop any significant complications.Conclusions: Tranexamic acid can be used safely as a prophylaxis to reduce blood loss during caesarean section.

Comparison of Blood Loss with the Use of Intravenous and Intraarticular Tranexamic Acid Versus Isolated Intraarticular in Primary Knee Arthroplasty / Comparação da perda sanguínea com a utilização do ácido tranexâmico endovenoso e intra-articular versus intra-articular isolado em artroplastia primária de joelho

Abstract Objective The objective of this work is to compare blood loss during primary knee arthroplasty with the use of intravenous and intraarticular (IV + IA) tranexamic acid versus intraarticular (IA) tranexamic acid alone. Methods This is a randomized, double-blind clinical trial. Patients with indication for primary total knee arthroplasty were recruited in a specialized clinic, where they were operated by the same surgeon, always using the same surgical technique. Thirty patients were allocated in the IV + IA tranexamic acid group and 30 patients in the IA tranexamic acid group, according to randomization. Blood loss was compared through hemoglobin, hematocrit, drain volume, and blood loss estimation (Gross and Nadler calculus). Results After collection, data from 40 patients were analyzed, 22 in the IA group and 18 in the IV +IA group. There were 20 losses due to collection error. Between groups IA and IV + IA, there were no significant differences in 24 hours between hemoglobin levels (10.56 vs. 10.65 g/dL; F1.39 = 0.63, p =0.429), erythrocyte (3.63 vs. 3.73 million/mm³; F1.39 = 0.90, p = 0.346); hematocrit (32.14 vs. 32.60%; F1.39 = 1.39, p = 0.240); drainage volume (197.0 vs. 173.6 mL; F1.39 = 3.38 p = 0.069); and estimated blood loss (1,002.5 vs. 980.1; F1.39 =0.09, p = 0.770). The same occurred in comparisons conducted after 48 hours postoperatively. Time was a significant factor for the change of all outcome variables. However, the treatment did not modify the effect of time on these outcomes. No individual presented any thromboembolic event during the work period. Conclusions The use of IV + IA tranexamic acid showed no advantage in reducing blood loss when compared to the use of IA tranexamic acid alone in primary knee arthroplasties. This technique proved to be safe, since no thromboembolic event occurred during the development of the work.

Resumo Objetivo O objetivo desse trabalho é comparar a perda sanguínea durante a artroplastia primária de joelho, com a utilização do ácido tranexâmico endovenoso e intra-articular (EV + IA) versus intra-articular (IA) isolado. Métodos Trata-se de um ensaio clínico randomizado, duplo cego. Pacientes com indicação de artroplastia total primária de joelho foram captados em clínica especializada, onde foram operados pelo mesmo cirurgião, utilizando sempre a mesma técnica cirúrgica. Trinta pacientes foram alocados no grupo ácido tranexâmico EV + IA e 30 pacientes, no grupo IA, conforme randomização. Foi comparada a perda sanguínea através dos níveis de hemoglobina, hematócrito, volume do dreno e estimativa da perda sanguínea (EBL) (cálculo de Gross e Nadler). Resultados Após a coleta, foram analisados os dados de 40 pacientes, sendo 22 do grupo IA isolado e 18 do grupo EV + IA. Ocorreram 20 perdas por erro de coleta. Entre os grupos IA e EV + IA, não ocorreram diferenças significativas em 24 horas entre os níveis de hemoglobina (10,56 vs. 10,65 g/dL; F1,39 =0,63, p = 0,429), eritrócito (3,63 vs. 3,73 milhões/mm3; F1,39 = 0,90, p =0,346), hematócrito (32,14 vs. 32,60%; F1,39 = 1,39; p=0,240), volume de dreno (197,0 vs. 173,6 mL; F1,39 = 3,38; p =0,069) e estimativa de perda sanguínea (EBL) (1.002,5 vs. 980,1; F1,39 = 0,09; p =0,770). O mesmo ocorreu nas comparações realizadas 48 horas pós-operatório. O tempo foi fator significativo para a mudança de todas as variáveis de desfecho. Porém, o tratamento não modificou o efeito do tempo nesses desfechos. Nenhum indivíduo apresentou qualquer evento tromboembólico durante o período do trabalho. Conclusões O uso do ácido tranexâmico EV + IA não demonstrou vantagem em redução de perda sanguínea quando comparado ao uso de ácido tranexâmico IA isolado nas artroplastias primárias de joelho. Esta técnica demonstrou-se segura, visto que nenhum evento trombo-embólico ocorreu durante o desenvolvimento do trabalho.

A clinical trial to assess the blood loss in women predisposed to postpartum hemorrhage with the use of prophylactic intravenous tranexamic acid

Background: Postpartum hemorrhage (PPH), a complication encountered during third stage of labour, contributes to 25% of maternal death worldwide. Despite various measures for prevention and management of PPH, burden of PPH still looms.Methods: Prospective randomized controlled clinical trial (RCT) was conducted in Vydehi Institute of Medical Sciences, among 128 patients predisposed to PPH, over 18 months. After meeting the inclusion and exclusion criteria, participants were randomized to receive tranexamic acid (TXA) intravenously 10 mg/kg along with 10 IU of oxytocin following the delivery. Patients were analysed for, blood loss, need for medical or surgical interventions.Results: Parameters like age, mean gestational age at haemoglobin estimation, and at delivery were similar among groups. The need or parenteral iron, blood transfusions, uterine artery ligation and compression suture were higher in controls group, but not statistically significant. Among the cesarean section (CS) group, most significant pre-disposing factors for PPH were previous CS (p value=0.012) and anaemia (p value =0.01). Incidence of PPH 0.69% (p value =0.031) and use of additional uterotonics were statistically significant (p value <0.05). Among the vaginal delivery (VD) group, most significant pre-disposing factors were anaemia (p value =0.002), thrombocytopenia (p value =0.045), and fetal-macrosomia (p value =0.020). Incidence of PPH 0.25% (p value <0.001) and use of additional uterotonics and hospital stay were statistically significant.Conclusions: We conclude that, anemic patients were at higher risk of PPH irrespective of the mode of delivery. Prophylactic TXA lowers incidence of PPH, blood loss, use of additional uterotonics and hospital stay even in the presence of pre-disposing factors. Quantification of blood loss is better estimated by drop in haemoglobin after 24 hours.

Design and application of a new device for measuring postpartum blood loss after vaginal delivery / 中国实用护理杂志

Objective:To explore the application effects of a new self-designed device for measuring postpartum blood loss in women with postpartum hemorrhage after vaginal delivery, so as to provide a basis for early identification and treatment of postpartum hemorrhage.Methods:The research was a quasi-experiment study. A total of 12 824 women who delivered vaginally in Women's Hospital of Nanjing Medical University from July 2021 to June 2022 were conveniently selected. Among them, the pregnant women enrolled from January to June 2022 were selected as the experimental group, and the pregnant women enrolled from July to December 2021 were included in the control group, with 6 412 cases in each group. The self-designed new postpartum blood loss measuring device was used to evaluate the blood loss in the experimental group, while the traditional blood collecting basin was taken in the control group.The differences between the two groups in the assessment error of 24 hours postpartum blood loss, postpartum blood loss at 2 hours and 24 hours, postpartum hemorrhage rate, severe postpartum hemorrhage rate and midwives′ satisfaction with the assessment of blood loss were compared.Results:The assessment error of 24 hours postpartum blood loss in the experimental group was 180.00 (80.00, 300.00) ml, which was lower than 192.00 (80.00, 310.00) ml in the control group, and the difference was statistically significant ( Z = - 2.04, P<0.05). The postpartum blood loss at 2 hours and 24 hours in the experimental group was 312.00 (290.00, 330.00) ml and 415.00 (385.00, 440.00) ml, respectively, which was higher than 310.00 (280.00, 330.00) ml and 407.00 (380.00, 435.00) ml in the control group, and the differences were statistically significant ( Z = - 9.86, - 5.42, both P<0.001). The rates of postpartum hemorrhage and severe postpartum hemorrhage in the experimental group were 6.50% (417/6 412) and 2.21% (142/6 412), respectively, higher than 4.71% (302/6 412) and 1.59% (102/6 412) in the control group, and the differences were statistically significant ( χ2 = 19.49, 6.69, both P<0.05). Midwives′ satisfaction score with the assessment of blood loss in the experimental group was (18.17 ± 1.02) points, higher than that in the control group (17.78 ± 1.17) points, and the difference was statistically significant ( t = 2.33, P<0.05). Conclusions:The use of a new device for measuring postpartum bleeding during vaginal delivery can reduce errors in evaluating postpartum blood loss within 24 hours, improve the detection rate of postpartum hemorrhage and severe postpartum hemorrhage, and midwives are satisfied with it.