Hidden blood loss during posterior spine fusion surgery: in response to the letter by ZhiNan et al.

Abstract Background： This study aimed to compare the clinical results between the Wiltse approach and traditional approach in lumbar spine fusion. Methods: In this retrospective controlled study, from May 2016 to May 2017, 70 cases with lumbar spine fusion surgery for lumbar disc herniation or lumbar spondylolisthesis within Ⅱdegree were assigned to Wiltse approach (35 cases,18 males and 17 females; mean age 52 years) and traditional approach groups (35cases, 19 males, 16 females; 51 years). There were totally 38 cases of lumbar disc herniation and 32 cases of II- degree spondylolisthesis in two groups. The operation time, the amount of blood loss and post-operation drainage, the level of creatine phosphokinase (CK) and the reduction of cross sectional area (CSA) in magnetic resonance imaging (MRI) were recorded. Results: After the operation for the Wiltse approach group, there was less operation time, blood loss and post-operative drainage (p＜0.05) ;the peripheral blood CK levels was changed a lot in 1 day and 3 days after the operation. In the Wiltse group, the reduction of CSA was significantly lower than traditional approach group in MRI. Conclusion: For lumbar spinal fusion surgery, the Wiltse approach do have shorter operation time and smaller vertebral side muscle injury compared with the traditional approach. However, in determining the operation program, the performer should fully recognize that the Wiltse clearance may have different influence on the operation at different anatomical level.

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Increased Nociception Following Administration of Different Doses of Tranexamic Acid in Adolescent Idiopathic Scoliosis Surgery

The Open Anesthesia Journal ◽

10.2174/2589645801812010061 ◽

2018 ◽

Vol 12 (1) ◽

pp. 61-68 ◽

Cited By ~ 3

Author(s):

Ashraf Nabil Saleh ◽

Raham Hasan Mostafa

Keyword(s):

Idiopathic Scoliosis ◽

Tranexamic Acid ◽

Maintenance Dose ◽

Spine Fusion ◽

Single Stage ◽

Scoliosis Surgery ◽

Loading Dose ◽

Fusion Surgery ◽

Posterior Spine ◽

Different Doses

Background:The inhibitory effect of Tranexamic Acid (TXA) on γ-aminobutyric acid and glycine receptors of spinal dorsal horn neurons which leads to pain arousal, has been highlighted recently in animal studies. Such findings would elicit concerns about adverse effects of TXA as a routine agent used to reduce perioperative blood loss.Objectives:This study aimed to evaluate the effect of different doses of TXA on analgesic requirements in adolescent patients undergoing elective single-stage posterior spine fusion surgery for idiopathic scoliosis.Patients and Methods:This prospective, randomized, double-blinded study comprised 75 patients who were randomly allocated to one of three groups. Each group comprised 25 patients. In group C (Control), patients received normal saline. While in group HD (High Dose), patients received TXA with a loading dose of 50 mg/kg and maintenance dose of 20 mg/kg/h and patients in group LD (Low Dose) received TXA with a loading dose of 10 mg/kg and maintenance dose of 1 mg/kg/h. The total intraoperative fentanyl dose was calculated for each patient which we used as a measure of the patients’ nociception level.Results:Group HD patients’ required the highest dose of fentanyl compared to those in LD group (mean of 60µgversus27µg). Patients in group C received no extra intraoperative narcotic doses and experienced the longest duration of surgical procedure. These results showed high statistically significant difference (p< 0.001).Conclusion:Intraoperative administration of TXA increases the analgesic requirement during elective single stage posterior spine fusion surgery which likely reflects an increase in patients’ intraoperative nociception.

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