Intravenous oxytocin bolus and infusion versus infusion alone on the blood loss during caesarean section

Background: PPH is one of the leading causes of maternal mortality in the world. In India >30% maternal mortality is because of PPH.Methods: 250 females posted for LSCS were randomised into 2 groups. Group A: 5U oxytocin bolus + 40U oxytocin infusion @125 ml/hour in 500 ml saline. Group B: 5 ml Saline bolus + 40 U oxytocin infusionPrimary outcome was to measure blood loss (objective and subjective). Secondary outcomes were time for uterine hardening, additional uterotonic agents, hemodynamic changes, side effects and need for blood transfusion within 24 hours of LSCS.Results: Blood loss was significantly less in Group A in objective as well as subjective assessment (p<0.001). Requirement for additional oxytocin bolus was significantly higher in Group B as compared Group A (p=0.025). Postoperative hematocrit of Group A was higher than that of Group B (p<0.001). Transfusion requirement was significantly higher (p=0.04) in Group B (9.6% versus 3.2%). There was no significant difference in hemodynamics between the groups in the intraoperative period (p>0.05). However, during the postoperative period increase in heart rate was noted in Group B (p<0.05). Vomiting was the only major side effect observed, which was higher in Group A (5.6% versus 3.2%).Conclusions: Combination of 5U oxytocin bolus followed by an infusion of 40 U oxytocin given over 4 hours routinely in ASA grade I and ASA grade II parturient significantly decreases the operative blood loss during LSCS without causing any hemodynamic variability. This regimen provides better uterine contractility, lesser need for additional utero-tonic agents and lesser requirement of blood transfusion.

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Prospective randomized trial comparing efficacy and safety of intravenous and intra-articular tranexamic acid in total knee arthroplasty

Knee Surgery and Related Research ◽

10.1186/s43019-020-00079-8 ◽

2020 ◽

Vol 32 (1) ◽

Author(s):

Moses Man-Lung Li ◽

Jojo Yan-Yan Kwok ◽

Kwong-Yin Chung ◽

Kin-Wing Cheung ◽

Kwok-Hing Chiu ◽

...

Keyword(s):

Total Knee Arthroplasty ◽

Body Weight ◽

Blood Transfusion ◽

Blood Loss ◽

Efficacy And Safety ◽

Significant Difference ◽

Group A ◽

Total Knee ◽

Group B ◽

Adjusted Dose

Abstract Background Total knee arthroplasty (TKA) is associated with significant perioperative blood loss and postoperative allogenic blood transfusion. Tranexamic acid (TXA) reversibly blocks lysine binding sites on plasminogen molecules and inhibits plasmin formation. Comparisons of the efficacy and safety of intra-articular and intravenous TXA in primary TKA have not previously been reported. Methods A prospective randomized trial was conducted in 150 patients who underwent TKA, and these patients were randomized into three groups. Patients in Group A were injected by intra-articular TXA according to body weight (20 mg/kg). Patients in Group B received a standard dose of intra-articular TXA (2000 mg), and those in Group C were infused with TXA according to body weight (20 mg/kg) before tourniquet deflation and again 3 h later. Baseline characteristics and data collected at blood transfusion were compared. Differences among four time points (baseline, day 0, day 2, and day 5) were carried out using ANOVA. Results The hemoglobin levels at postoperative day 5 were 10.6 g/dL for Group A, 10.6 g/dL for Group B, and 10.7 g/dL for Group C. The drain output was 399 ml for Group A, 314 ml for Group B, and 305 ml for Group C (p = 0.03). Group C had significantly less drain output than Group A after post hoc comparisons (p = 0.05), whereas no significant difference was observed between Group A and B (p = 0.09) or between Group B and C. Conclusion The weight-adjusted dose of TXA administered intravenously significantly reduced the drain output but not the total blood loss when compared with the weight-adjusted dose of TXA administered intra-articularly. No significant difference was observed in the other parameters among the three groups. Trial registration The Joint CUHK-NTEC CREC, CRE-2013.644-T. Registered 1 March 2014.

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Total Knee Arthroplasty with and without Tourniquet: Comparative study

10.21203/rs.3.rs-10928/v1 ◽

2020 ◽

Author(s):

Sherwan Hamawandi ◽

Hazhar I. Amin ◽

Ameer Kadhim Al-Humairi

Keyword(s):

Blood Transfusion ◽

Blood Loss ◽

Knee Arthroplasty ◽

Thigh Pain ◽

Early Recovery ◽

Significant Difference ◽

Duration Of Surgery ◽

Group A ◽

Group B ◽

Without Tourniquet

Abstract Background The use of tourniquet during complete knee arthroplasty (TKA) improves protection and reduces blood loss intraoperative. Turniquet use, however, may also have a negative impact after TKA on early recovery of muscle strength and lower extremity function. The purpose of this study was to demonstrate the effect of tourniquet use in TKA on surgery length, need for blood transfusion, and amount of postoperative blood drainage by suction drain, incidence of postoperative wound hematoma, postoperative thigh pain, and early mobilization.Methods Seventy Patients are involved in this study and were divided into two groups; Group A (35) patients were treated with TKA with pneumatic thigh tourniquet. Group B (35) patients were treated with TKA without tourniquet. All patients were suffering from severe knee osteoarthritis and they failed to respond to conservative treatment so they are candidates for primary TKA. The two groups are matched related to age and gender. Selection of patients into two groups done randomly with regard of odd number for group A and even number for group B.Results The results showed no significant difference regarding age, gender, postoperative DVT and wound hematoma between group A (when tourniquet was used) and group B (when tourniquet was not used) although we have 2 patients developed DVT and 3 patients had wound hematoma in group A but these are statistically not significant. Regarding post-operative VAS for thigh pain was significantly less in group B and this will result in early mobilization. Also there was significant difference in duration of surgery between two groups with less time in group A due to bloodless field of tourniquet while there was significantly more postoperative drainage amount of blood through the surgical drains in group A and significantly more amount of blood transfusion perioperatively in group B which explain that tourniquet can reduce the total amount of blood loss in TKA.Conclusion There is significant effect of tourniquet in TKA on thigh pain postoperatively, which will effect postoperative mobilization and rehabilitation. Also the tourniquet can result in significant reduction in time of operation, total blood loss and amount of blood transfusion.

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Total Knee Arthroplasty with and without Tourniquet: Comparative study

10.21203/rs.3.rs-17527/v1 ◽

2020 ◽

Author(s):

Sherwan Hamawandi ◽

Hazhar I. Amin ◽

Ameer Kadhim Al-Humairi

Keyword(s):

Blood Transfusion ◽

Blood Loss ◽

Knee Arthroplasty ◽

Early Mobilization ◽

Thigh Pain ◽

Significant Difference ◽

Duration Of Surgery ◽

Group A ◽

Group B ◽

Without Tourniquet

Abstract Background: The use of tourniquet during complete knee arthroplasty (TKA) improves protection and reduces blood loss intraoperative. Turniquet use, however, may also have a negative impact after TKA on early recovery of muscle strength and lower extremity function. The purpose of this study was to demonstrate the effect of tourniquet use in TKA on surgery length, need for blood transfusion, and amount of postoperative blood drainage by suction drain, incidence of postoperative wound hematoma, postoperative thigh pain, and early mobilization.Methods: Seventy Patients are involved in this study and were divided into two groups; Group A (35) patients were treated with TKA with pneumatic thigh tourniquet. Group B (35) patients were treated with TKA without tourniquet. All patients were suffering from severe knee osteoarthritis and they failed to respond to conservative treatment so they are candidates for primary TKA. The two groups are matched related to age and gender. Selection of patients into two groups done randomly with regard of odd number for group A and even number for group B.Results: The results showed no significant difference regarding age, gender ,postoperative DVT and wound hematoma between group A (when tourniquet was used) and group B (when tourniquet was not used) although we have 2 patients developed DVT and 3 patients had wound hematoma in group A but these are statistically not significant. Regarding post-operative VAS for thigh pain was significantly less in group B and this will result in early mobilization. Also there was significant difference in duration of surgery between two groups with less time in group A due to bloodless field of tourniquet while there was significantly more postoperative drainage amount of blood through the surgical drains in group A and significantly more amount of blood transfusion perioperatively in group B which explain that tourniquet can reduce the total amount of blood loss in TKA.Conclusion: There is significant effect of tourniquet in TKA on thigh pain postoperatively, which will effect postoperative mobilization and rehabilitation. Also the tourniquet can result in significant reduction in time of operation, total blood loss and amount of blood transfusion.Trial registration: NCT, NCT04130009. Registered 17 October 2019 - Retrospectively registered, https://clinicaltrials.gov/NCT04130009

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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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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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Evaluation of maternal and perinatal morbidity and mortality in eclampsia by early termination of pregnancy

International Journal of Research in Medical Sciences ◽

10.18203/2320-6012.ijrms20204241 ◽

2020 ◽

Vol 8 (10) ◽

pp. 3629

Author(s):

Suresh C. Mondal ◽

Sandip Lahiri

Keyword(s):

Caesarean Section ◽

Maternal Mortality ◽

Termination Of Pregnancy ◽

Early Termination ◽

Early Presentation ◽

Neonatal Deaths ◽

Still Births ◽

Significant Difference ◽

Group A ◽

Group B

Background: Eclampsia is one of the leading causes of maternal mortality in India.Methods: A prospective observational study was done on 200 pregnant women admitted with antepartum eclampsia in Malda Medical College from 1 April 2017 to 30 October 2019. Group A included patients who delivered through vaginal route within 10 to 12 hrs of eclampsia by stabilisation of patients while Group B included subjects who underwent early caesarean section for uncontrolled convulsions or poor Bishop score. Maternal and perinatal outcomes were compared between the groups. Data was recorded in a pretested performa and was analyzed using appropriate statistical methods with SPSS.Results: Caesarean section (group B) was done in 130 cases (65%) while vaginal delivery (group A) was done in 65 cases (37.5%). Group A had higher maternal mortality (10.7%) in comparison to group B (4.6%) which was statistically not significant (p=0.1075). There were 32 neonatal deaths (24.6%) and 11 still births (8.46%) in group A while there were 12 neonatal deaths (18.46%) and 3 still births (4.61%) in group B. There was a statistically significant difference (p<0.0001) between the groups with respect to total perinatal deaths.Conclusions: Antenatal and intranatal eclampsia should be managed by early termination of pregnancy preferably with Caesarean section. Early presentation and timely decision to terminate pregnancy will improve the maternal and perinatal outcome.

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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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Third stage of labour: expectant versus active management-a comparative study in local low risk population

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20190298 ◽

2019 ◽

Vol 8 (2) ◽

pp. 641

Author(s):

Kavita A. Chandnani ◽

Deepti D. Sharma

Keyword(s):

Blood Loss ◽

Comparative Study ◽

Maternal Mortality ◽

Post Partum ◽

Expectant Management ◽

Active Management ◽

Research Centre ◽

Third Stage ◽

Group A ◽

Group B

Background: Postpartum haemorrhage (PPH) is the leading cause of maternal mortality, accounting for about 35% of all maternal deaths. These deaths have a major impact on the lives and health of the families affected. Thus, anticipation as well as proper management of 3rd stage of labour is mandatory. The objective of this study was to compare expectant and active management of third stage of labour in preventing post-partum blood loss and having impact on prevention of maternal mortality in local population. Advantages and disadvantages of both techniques might be over estimated.Methods: Prospective comparative study carried out in Obstetrics and Gynecology department of SBKSMIRC (Shrimati Bhikhiben Kanjibhai Shah Medical Institute and Research Centre), Dhiraj general hospital, comprising of 200 laboring women admitted directly or from OPD to labour room for expected vaginal delivery. They were randomly allocated to group A (expectant management) and group B (active management). Labour progress was charted on partograph and interventions recorded. Statistical analysis of data was done after compiling and tabulation of data. Mean±SD for descriptive variables were calculated and appropriate statistical tests applied to determine significance.Results: Average PPBL (post-partum blood loss) was 360.5ml in group A as compared to 290.6ml in group B. 12 patients in group A had blood loss more than 500ml while none in group B. 66% cases in group B had duration of third stage of labour less than 5 min as compared to only 22% in group A. the mean duration of third stage was 13.46±8.3 in group A while 5.32±3.05 in group B. these differences were statistically significant.Conclusions: Active management of the third stage of labour is associated with less blood loss as well as a shorter duration of third stage compared with expectant management. It is reasonable to advocate this regime.

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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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Tranexamic Acid in Pertrochanteric Femoral Fracture: Is it a Safe Drug or Not?

Folia Medica ◽

10.1515/folmed-2017-0070 ◽

2018 ◽

Vol 60 (1) ◽

pp. 67-78 ◽

Cited By ~ 7

Author(s):

Andrea Schiavone ◽

Michele Bisaccia ◽

Ivan Inkov ◽

Giuseppe Rinonapoli ◽

Mattia Manni ◽

...

Keyword(s):

Blood Transfusion ◽

Blood Loss ◽

Tranexamic Acid ◽

Vascular Events ◽

Safety Criterion ◽

Post Surgery ◽

High Incidence ◽

Group A ◽

Group B ◽

D Dimer

AbstractBackground:There is a high incidence of blood transfusion following hip fractures in elderly patients.Aim:The aim of this study is to evaluate the effectiveness and complications of use of tranexamic acid in proximal femur nailing surgery.Materials and methods:Our sample group consisted of 90 patients suffering from pertrochanteric fractures surgically treated with osteosynthesis with SupernailGT(LimaCorporate). The classification system AO/OTA was used to divide the fractures into 31A1 (n=45) and 31A2 (n=45). The patients were divided into two groups: 47 patients were administered 15 mg of tranexamic acid per kg (group A) and 43 patients were administered placebo (group B). Blood counts were monitored daily to evaluate the rate of anemia. As a safety criterion, we monitored the possible occurrence of vascular events, symptomatic or not, over the 8 weeks post-surgery. Markers predicting mortality and deep venous thrombosis (DVE) were also monitored (fibrinogen D-dimer).Results:Blood loss occurring post-surgery can be influenced by numerous factors that are not linked to the use or non-use of tranexamic acid. While closely monitoring hemoglobin levels daily, we observed that 42% of the patients in group A required blood transfusion as opposed to 60% in group B. The results of the markers predicting mortality (alpha1-acid glycoprotein; albumin LDL) and those of DVE were not statistically significant between the two groups in this study (p>0.05).Conclusion:Based on this study, the use of tranexamic acid was statistically significant in reducing post-surgery blood loss.

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