Effects of Local Administration of Tranexamic Acid on Reducing Postoperative Blood Loss in Surgeries for Closed, Sanders III–IV Calcaneal Fractures: A Randomized Controlled Study

Abstract Purpose To investigate whether local administration of tranexamic acid (TXA) is effective in postoperative blood loss reduction in surgeries for Sanders III–IV calcaneal fractures. Methods Calcaneal fracture patients who were hospitalized in our hospital from August 2014 to April 2018 and underwent open reduction internal fixation (ORIF) via lateral approach with an L-shaped incision were included in the present study. 53 Patients were randomly divided into three groups, groups A (17), B (17) and C (19). Twenty milliliters of 10 mg/ml and 20 mg/ml TXA solution were perfused into the incision of patients in group A and group B, respectively. Twenty milliliters of saline were perfused into the incision of patients in group C as control. The volume of postoperative drainage, postoperative blood test, coagulation test, and wound complications were analyzed to evaluate the effectiveness of local administration of TXA on blood loss reduction. Results The amount of drainage at 24 and 48 h after the procedure was 110 ± 170, 30 ± 10 ml and 130 ± 160, 20 ± 17 ml for patients in group A and group B, respectively. The corresponding numbers for patients in group C were 360 ± 320, 20 ± 10 ml. The difference between group A and group C was statistically significant, so was the difference between group B and group C. No statistically significant difference was found between group A and group B. Postoperative blood test results revealed that the levels of hemoglobin and hematocrit were significantly higher in group A and group B when each compared to that of group C. In contrast, no difference was found between group A and group B. No significant difference was found between each experimental group and the control group in terms of platelet counts, prothrombin time (P.T.), activated partial prothrombin time (APTT), and wound complications. Conclusion Local administration of TXA is effective in the reduction of postoperative blood loss in surgeries for Sanders III–IV types of calcaneal fractures without notably associated side effects.

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Comparison the Postoperative Blood Loss in Total Knee Arthroplasty with and without Perioperative Tourniquet Release

10.53350/pjmhs211551142 ◽

2021 ◽

Vol 15 (5) ◽

pp. 1142-1143

Author(s):

S. Aziz ◽

S. Ahmed ◽

S. A. Mahar ◽

S. Ali ◽

J. Kumar

Keyword(s):

Total Knee Arthroplasty ◽

Blood Loss ◽

Knee Arthroplasty ◽

Postoperative Blood Loss ◽

Keywords Total Knee Arthroplasty ◽

Significant Difference ◽

Tourniquet Release ◽

Group A ◽

Total Knee ◽

Group B

Objective: To compare the postoperative blood loss in total knee arthroplasty with and without perioperative tourniquet release. Study Design: Randomized control trial Place & Duration of Study: Department of Orthopaedic, M. Islam Teaching Hospital Gujranwala 1st January 2020 to 31st December 2020. Methodology: Ninety patients of both genders undergoing total knee arthroplasty were included in this study. Patient’s demographics were recorded after written consent. Patients were equally divided into two groups. Group A (45 patients) received total knee arthroplasty with tourniquet while group B (45 patients) received total knee arthroplasty without tourniquet. Postoperative blood loss was measured by suction drain, levels of haemoglobin were examined and compare between two groups. Results: The mean age of the patients in group A was 57.76±2.4 years while in group B it was 58.16±7.8 years. 32 (71.11%) and 34 (75.56%) were males while 13 (28.89%) and 11 (24.44%) were females in group A and B. We observed patients at the three different points and found lower blood loss in patients who received total knee arthroplasty with tourniquet as compared to no tourniquet group (p-value <0.05). No significant difference was observed regarding hemoglobin at 2 hours and significant differences were observed at 24 and 48 hour postoperatively. Conclusion: Tourniquet is useful to decrease loss of blood in patients undergoing total knee arthroplasty. Keywords: Total knee arthroplasty (TKA), Tourniquet, Blood loss

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Local administration of epsilon-aminocaproic acid reduces post-operative blood loss from surgery for closed, Sanders III–IV calcaneal fractures

International Orthopaedics ◽

10.1007/s00264-021-05268-y ◽

2022 ◽

Author(s):

Lang Zhong ◽

Yangbo Xu ◽

Yongcai Wang ◽

Yu Liu ◽

Qiu Huang

Keyword(s):

Blood Loss ◽

Aminocaproic Acid ◽

Wound Complications ◽

Local Administration ◽

Control Group ◽

Calcaneal Fractures ◽

Operative Blood Loss ◽

Significant Difference ◽

Operative Drainage ◽

And Control

Abstract Purpose To investigate whether local administration of epsilon-aminocaproic acid (EACA) is effective and safe in reducing the post-operative blood loss in surgery for Sanders III–IV calcaneal fractures. Methods Patients with Sanders III–IV calcaneal fractures who were hospitalized in our hospital from January 2016 to February 2021 and underwent open reduction internal fixation (ORIF) via lateral approach with an L-shaped incision were included in the current study. Eighty five patients were randomly divided into two groups, EACA group (43) and control group (42). Twenty milliliters of 5% EACA solution or normal saline was perfused into the incision of patients in EACA group and control group, respectively. The volume of post-operative drainage was investigated as the primary outcome. Post-operative blood test, coagulation test, and wound complications were analyzed as the secondary outcomes. Results The volume of post-operative drainage at 24 and 48 h was 164.8 ± 51.4 ml, 18.9 ± 3.8 ml for patients in EACA group, and 373.0 ± 88.1 ml, 21.2 ± 4.4 ml for patients in the control group, respectively. EACA greatly reduced the post-operative blood loss compared to the control (normal saline). The difference between the two groups was statistically significant. No statistically significant difference was found between EACA group and control group with regard to the pre-operative, baseline characteristics. Post-operative blood test results demonstrated that haemoglobin and hematocrit were significantly higher in EACA compared to those of control group. No significant difference was found between EACA group and control group in terms of the platelet counts, prothrombin time (P.T.), activated partial prothrombin time (APTT), and wound complications. Conclusion Local administration of EACA is effective in post-operative blood loss reduction in ORIF surgeries for Sanders III–IV types of calcaneal fractures without increasing the incidence of periwound complication.

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Microsurgical unilateral laminotomy for bilateral decompression of degenerative lumbar canal stenosis: a comparative study

The Egyptian Journal of Neurology Psychiatry and Neurosurgery ◽

10.1186/s41983-019-0125-4 ◽

2019 ◽

Vol 55 (1) ◽

Author(s):

Mohamed I. Refaat ◽

Amr K. Elsamman ◽

Adham Rabea ◽

Mohamed I. A. Hewaidy

Keyword(s):

Patient Satisfaction ◽

Blood Loss ◽

Minimally Invasive ◽

Invasive Technique ◽

Decompression Surgery ◽

Microsurgical Decompression ◽

Significant Difference ◽

Duration Of Surgery ◽

Group A ◽

Group B

Abstract Background The quest for better patient outcomes is driving to the development of minimally invasive spine surgical techniques. There are several evidences on the use of microsurgical decompression surgery for degenerative lumbar spine stenosis; however, few of these studies compared their outcomes with the traditional laminectomy technique. Objectives The aim of our study was to compare outcomes following microsurgical decompression via unilateral laminotomy for bilateral decompression (ULBD) of the spinal canal to the standard open laminectomy for cases with lumbar spinal stenosis. Subjects and methods Cases were divided in two groups. Group (A) cases were operated by conventional full laminectomy; Group (B) cases were operated by (ULBD) technique. Results from both groups were compared regarding duration of surgery, blood loss, perioperative complication, and postoperative outcome and patient satisfaction. Results There was no statistically significant difference between both groups regarding the improvement of visual pain analogue, while improvement of neurogenic claudication outcome score was significant in group (B) than group (A). Seventy-three percent of group (A) cases and 80% of group (B) stated that surgery met their expectations and were satisfied from the outcome. Conclusion Comparing ULBD with traditional laminectomy showed the efficacy of the minimally invasive technique in obtaining good surgical outcome and patient satisfaction. There was no statistically significant difference between both groups regarding the occurrence of complications The ULBD technique was found to respect the posterior spinal integrity and musculature, accompanied with less blood loss, shorter hospital stays, and shorter recovery periods than the open laminectomy technique.

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Does body position, age, and heart rate induce IOP’s changes?

European Journal of Ophthalmology ◽

10.1177/11206721211023313 ◽

2021 ◽

pp. 112067212110233

Author(s):

Marcelina Sobczak ◽

Magdalena Asejczyk ◽

Malwina Geniusz

Keyword(s):

Heart Rate ◽

Body Position ◽

Age Groups ◽

Cardiovascular Parameters ◽

Entire Cohort ◽

Significant Difference ◽

Group A ◽

The Difference ◽

Group B ◽

Effect Of Age

Objectives: The main goal of this research was to determine the differences between the values of intraocular pressure (IOP) in the supine and sitting positions, and to assess the effect of age and cardiovascular parameters. Methods: Seventy-two healthy adults were enrolled and classified into age groups: 20–30 years (group A), 31–40 years (group B), and 41–71 years (group C). Corneal biometry and cardiovascular parameters, such as heart rate (HR), were measured. IOP measurements were taken in the sitting position (IOPS) and in the supine position (IOPL) using the iCare® Pro tonometer. Results: A significant difference between the IOPS and IOPL in the entire cohort was found ( p < 0.001). Regarding the age subgroups, a significant difference ( p < 0.001) between the IOPS and IOPL was obtained in group A (2.6 ± 1.6 mmHg) and group C (1.5 ± 1.3 mmHg). There were no significant differences in the IOPS between groups. The highest IOP values were obtained for group A. The correlations between HR and IOPS are statistically significant for group A and group B, and for HR and IOPL-S for group B only. Multivariate analysis showed that HR has a significant influence on the difference in IOP in the two body positions. Conclusion: A statistically significant difference between the effect of age and the values of IOPS and IOPL was shown. Cardiovascular parameters showed some relevant statistical dependencies, but with a rather marginal significance in young people. The influence of body position for the measurement of IOP for healthy subjects does not seem to matter, despite the fact that there are some dependencies that are statistically significant.

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Comparison between scalpel incision and electrocautery incision in midline abdominal surgery: a comparative study

International Surgery Journal ◽

10.18203/2349-2902.isj20211817 ◽

2021 ◽

Vol 8 (5) ◽

pp. 1507

Author(s):

Amit Yadav ◽

Lakshman Agarwal ◽

Sumit A. Jain ◽

Sanjay Kumawat ◽

Sandeep Sharma

Keyword(s):

Postoperative Pain ◽

Blood Loss ◽

Abdominal Surgery ◽

Wound Infection ◽

Skin Incision ◽

P Value ◽

Wound Area ◽

Significant Difference ◽

Group A ◽

Group B

Background: Fear of poor wound healing have curtailed the use of diathermy for making skin incision. Scalpel produces little damage to surrounding tissue but causing more blood loss. Our aim of study was to compare electrocautery incision with scalpel incision in terms of incision time, blood loss, postoperative pain and wound infection.Methods: Total of 104 patients were included in the study undergoing midline abdominal surgery. Patients were randomized into electrocautery (group A) and scalpel (group B). The incision dimension, incision time and blood loss were noted intraoperatively. Postoperative pain was noted on postoperative day 2 using visual analog scale. Wound complications were recorded on every postoperative day till the patient was discharged.Results: 52 patients in each of the two groups were analyzed. There was significant difference found between group A and group B in terms of mean incision time per unit wound area, 8.16±1.59 s\cm2 and 11.02±1.72 s\cm2 respectively (p value=0.0001). The mean blood loss per unit wound area was found to be significantly lower in group A (0.31±0.04 ml\cm2) as compared to group B (1.21±0.21), p value=0.0001. There was no significant difference noted in terms of postoperative pain and wound infection between both groups.Conclusions: Electrocautery can be considered safe in making skin incision in midline laparotomy compared to scalpel incision with comparable postoperative pain and wound infection with less intraoperative blood loss and less time consuming.

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Intravenous and subsequent long-term oral tranexamic acid in enhanced-recovery primary total knee arthroplasty without the application of a tourniquet: a randomized placebo-controlled trial

BMC Musculoskeletal Disorders ◽

10.1186/s12891-019-2885-5 ◽

2019 ◽

Vol 20 (1) ◽

Cited By ~ 2

Author(s):

Hao-Yang Wang ◽

Liu Wang ◽

Ze-Yu Luo ◽

Duan Wang ◽

Xin Tang ◽

...

Keyword(s):

Total Knee Arthroplasty ◽

Blood Loss ◽

Tranexamic Acid ◽

Knee Arthroplasty ◽

Total Blood ◽

Significant Difference ◽

Group A ◽

Total Knee ◽

Group B

Abstract Background To assess the efficacy and safety of intravenous and subsequent long-term oral tranexamic acid (TXA) following total knee arthroplasty (TKA) without a tourniquet. Methods In this double-blinded trial, 118 patients undergoing primary TKA were randomized into two groups: the patients in group A received intravenous TXA at 20-mg/kg 10 min before the surgery and 3 h postoperatively, and then oral 1 g TXA from postoperative day (POD) 1 to POD 14, and the patients in group B received intravenous TXA at 20-mg/kg 10 min before surgery and 3 h postoperatively, and then oral 1 g placebo from postoperative day (POD) 1 to POD 14. The primary outcome was total blood loss. Secondary outcomes included ecchymosis area and morbidity, postoperative transfusion, postoperative laboratory values, postoperative knee function and length of hospital stay. Complications, and patient satisfaction were also recorded. Results The mean total blood loss was lower in Group A than in Group B (671.7 ml vs 915.8 ml, P = 0.001). There was no significant difference in the transfusion rate between the two groups. Group A had a higher hemoglobin than Group B on POD 3 (106.0 g/L vs 99.7 g/L, P = 0.001). However, no significant difference was found for Hb or hematocrit on POD 1 or POD 14 between the two groups. Patients in Group A had less ecchymosis morbidity (7 vs 38, P = 0.001), smaller ecchymosis area (1.6 vs 3.0, P = 0.001) than Group B. The blood coagulation level as measured by fibrinolysis (D-Dimer) was lower in Group A than in Group B on POD 1 and POD 3 (4.6 mg/L vs. 8.4 mg/L, respectively, P = 0.001; 1.5 mg/L vs. 3.3 mg/L, respectively, P = 0.001). However, there was no significant difference on POD 14, and the fibrin degradation products showed the same trend. Patients in Group A had less swelling than those in Group B on POD 3 and POD 14. The circumference of the knee was 43.1 cm vs. 46.1 cm (POD 3, P = 0.001) and 41.4 cm vs. 44.9 cm (POD 14, P = 0.001) in Group A vs Group B, respectively. Nevertheless, the circumference of the knee in the two groups was similar on POD 1 and POD 3 M. No significant differences were identified in knee function, pain score, or hospital stay. No significant differences were identified in thromboembolic complications, infection, hematoma, wound healing and patients satisfaction between the two groups. Conclusion Intravenous and subsequent long-term oral TXA produced less blood loss and less swelling and ecchymosis compared with short-term TXA without increasing the risk of complications. Trial registration The trial was registered in the Chinese Clinical Trial Registry (ChiCTR-IPR-17012264).

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Impact of Preoperative Rectal Misoprostol on Blood Loss during and after Elective Cesarean Delivery: A Randomized Controlled Trial

Nepal Journal of Obstetrics and Gynaecology ◽

10.3126/njog.v11i2.17460 ◽

2017 ◽

Vol 11 (2) ◽

pp. 37-41 ◽

Cited By ~ 1

Author(s):

Sarita Sitaula ◽

DK Uprety ◽

A Thakur ◽

T Pradhan

Keyword(s):

Blood Loss ◽

Cesarean Delivery ◽

Intravenous Infusion ◽

Postoperative Blood Loss ◽

P Value ◽

Elective Cesarean Delivery ◽

Effective Measure ◽

Elective Cesarean ◽

Group A ◽

Group B

Aims:The aim of this study was to evaluate the effect of preoperative administration of rectal misoprostol onblood loss during and after elective cesarean delivery.Methods:It was a randomized trial including 200 women, divided into two groups (group A and group B), who were planned for elective cesarean delivery and didn’t have risk of postpartum hemorrhage (PPH). Group A received 400μg misoprostol per-rectal preoperatively and intravenous infusion of oxytocin after delivery as hospital protocol.Group B received only intravenous infusion of oxytocin. Primary outcome measureswere the estimated amount of intraoperative and postoperative (24 hours) blood loss and changes in hemoglobin levels 48 hours after delivery.Results:Intraoperative and postoperative blood loss in rectal misoprostol and oxytocin group were significantly reducedin comparison to oxytocin only group. Mean blood loss in groupA was 326.9±116.2 mlwhereas; in group B was 397.7±110.1 ml with p value of < 0.001 which was significant.The difference between preoperative and postoperative hemoglobin level after 48 hours was also significant (1.10±0.51 vs 1.35± 0.49 g/dl with p value <0.001).Conclusion: Preoperative rectal misoprostol was found to be an effective measure to reduce the intraoperative and postoperative blood loss during elective cesarean delivery.

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Postoperative Sore Throat, Nausea and Vomiting in Routine Nasal Surgery: Influence of Pharyngeal Packing

Galen Medical Journal ◽

10.31661/gmj.v1i1.7 ◽

2012 ◽

Vol 1 (1) ◽

pp. 24-28

Author(s):

Mehrdad Naderian ◽

Ehsan Jangholi ◽

Taraneh Kharaz Tavakol

Keyword(s):

Sore Throat ◽

Postoperative Nausea And Vomiting ◽

Nausea And Vomiting ◽

Control Group ◽

Nasal Surgery ◽

Significant Difference ◽

Group A ◽

The Difference ◽

Group B ◽

Pharyngeal Packing

Introduction: Pharyngeal packs are commonly used to prevent of postoperative nausea and vomiting (PONV) and Sore throat during nasal surgery following tracheal intubation. the aim of this study is evaluation of effectiveness of pharyngeal packing in the prevention of PONV. Materials and methods: This study with random sampling performed on 120 adult patients scheduled for routine nasal surgery referred Boo – Ali hospital in Tehran, Iran from March 2011 to March 2012. the study was approved in the ethical committee of Azad University and written informed consent to participate in the study. All subjects randomly allocated to Group A or Group B to have and not to have pharyngeal packing during surgery, Respectively.The incidence of PONV and sore throat in the recovery room,at 2 and 6 h were recorded by a 100 mm long visual analogue scale (VAS). Data were analysed using non-parametric tests in SPSS 18. Significant difference was set at p<0.05. Results: The average age of patients was 27.6 ± 7.1 years. The average of age in Group A was 29.2 ± 2.8 years and in Group B was 27.4 ± 3.2 years. The difference in throat pain scores in the two groups at each assessment time was statistically signiﬁcant. The difference in PONV scores were not statistically signiﬁcant. Conclusion: The usage of pharyngeal packing during nasal surgery leads to decreased incidence of sore throat in experiment group compared with the control group. Also has no effect on the incidence of PONV. [GMJ. 2012;1(1):24-28]

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The influence of balanced complex chromosomal rearrangements on preimplantation embryonic development potential and molecular karyotype

10.21203/rs.2.14678/v4 ◽

2020 ◽

Author(s):

Gang Li ◽

Weiyi Shi ◽

Wenbin Niu ◽

Jiawei Xu ◽

Yihong Guo ◽

...

Keyword(s):

Embryonic Development ◽

High Quality ◽

Preimplantation Genetic Testing ◽

Abnormal Embryo ◽

Significant Difference ◽

Molecular Karyotype ◽

Group A ◽

The Difference ◽

Group B ◽

Euploid Embryo

Abstract Background: Balanced complex chromosome rearrangements (BCCR) are balanced chromosomal structural aberrations that involve two or more chromosomes and at least three breakpoints. It is very rare in the population.The objective is to explore the difference of influence of three types of BCCR on early embryonic development and molecular karyotype.Results:Twelve couples were recruited including four couples of three-way rearrangements carriers (group A), three couples of double two-way translocations carriers (group B) and five couples of exceptional CCR carriers (group C). A total of 243 oocytes were retrievedin the seventeen preimplantation genetic testing (PGT) cycles, and 207 of these were available for fertilization.After intracytoplasmic sperm injection, 181oocytes normally fertilized. The rates of embryos forming on day3 in three groups were 87.88%, 97.78% and77.14%, which was significantly different (P=0.01). Compared with group B, the rate of embryo formation was statistically significantly lower in group C(P=0.01).Furthermore, the rates of high-quality blastocysts in three group were 14.71%, 48.15% and 62.96%, respectively, which was significantly different (P=0.00). Compared with group B andC, the rate of high-quality blastocysts in group A was statistically significantly lower (P=0.00;P=0.00). Comprehensive chromosome analysis was performed on 83 embryos, including 75 trophectodermcellsand 8 blastomeres. Except 7 embryos failed to amplify, 9.01%embryos were diagnosed as euploidy, and 90.91% were diagnosed as abnormal. As for group A, the euploid embryo rate was 10.71%and the abnormal embryo rate was 89.29%. In group B,the euploid embryo rate was 3.85%, the abnormal embryo rate was 96.15%. The euploid embryo rate was 13.04%, the abnormal embryo rate was 86.96% in group C.There were no significant differences among the three groups (P = 0.55).Conclusions:The lowest rate of high quality blastocysts has been for three-way rearrangements and the lowest rate of euploidy has been for double two-way translocations, although no significant difference. Different types of BCCR maybe have little effect on the embryonic molecular karyotype. The difference of influence of BCCR on early embryonic developmentandmolecular karyotypeshould be further studied.

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A Comparative Study of Oxytocin & Misoprostol in Active Management of Third Stage of Labour

Journal of Nepalgunj Medical College ◽

10.3126/jngmc.v12i1.13401 ◽

2015 ◽

Vol 12 (1) ◽

pp. 22-24

Author(s):

N Ansari ◽

CR Das

Keyword(s):

Blood Loss ◽

College Teaching ◽

Cross Sectional Study ◽

Active Management ◽

Cross Sectional ◽

Medical College ◽

Significant Difference ◽

Third Stage ◽

Group A ◽

Group B

Introduction: The third stage of labour is the period which follows the completed delivery of the foetus and consists of delivery of the placenta and its attached membranes.Aims and objectives: Comparison of oxytocin & misoprostol in active management of third stage of labour.Material and Methods: This is a comparative cross-sectional study was conducted in Nepalgunj Medical College Teaching Hospital, Kohalpur from March 2013 to March 2014. Group A - Oxytocin 10 IU IV bolus in 100 patients and Group B - Misoprostol 600 micro gram rectally. The collected were subjected to statistical analysis using SPSS 15.Results: After active management with bolus oxytocin, the blood loss was grossly reduced being 40-100ml in 84% cases and only 7% had blood loss more than 100ml. blood loss between 200-300ml were only 6% and only 3% had PPH, after misoprostol 80% of cases had blood loss within 40 – 100 ml., 6% cases had blood loss within 100 – 200 ml. and larger amount of blood loss i.e. between 200 – 300 ml. was observed in 7% cases, in 3% cases blood loss was between 300 – 400 ml. and 4% of women in this group had PPH.Conclusion: There was no statistically significant difference in the efficacy of oxytocin and misoprostol in reducing amount of blood loss and duration of labour rd in 3 stage of labour.Journal of Nepalgunj Medical College Vol.12(1) 2014: 22-24

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