effect of intravenous tranexamic acid on blood loss in lumbar hernial disc resection under inhalation and total intravenous anesthesia

ABSTRACT

Tranexamic acid is a synthetic antifibrinolytic drug that reduces bleeding and transfusion requirements in cardiac surgery and total knee arthroplasty. In this study, we evaluated the efficacy of the prophylactic tranexamic acid on intraoperative bleeding in patients undergoing lumbar hernial dics resection. Eighty patients in ASA class I and II were randomized into 4 groups. In group 1, anesthesia was achieved by total intravenous anaesthesia and also the administration of tranexamic acid. The other groups were group 2, anesthetized by total intravenous anaesthesia without tranexamic acid; group 3, anesthetized by halothane and the administration of tranexamic acid and group 4, anesthetized by halothane without tranexamic acid. Blood loss and surgeon's satisfaction were registered. The amount of blood loss in group 1 was 267.1 177.3 ml; in group 2 656 411.6 ml; in group 3 357 307.2 ml and in group 4 550 406.7 ml. The least bleeding was recorded in group 1 which had a significant difference with groups 2 and 4 for which tranexamic acid was not administered. Blood loss in groups 2 and 4 was more or less similar with no significant difference. The surgeon's highest satisfaction was with group 1. No complications were recorded in the 4 groups. We concluded that administration of prophylactic tranexamic acid in patients undergoing hernial disc resection has the potential to reduce intraoperative bleeding and improving visualization of the surgical field especially when administered with total intravenous anesthesia