Role of Amicar in surgery for neuromuscular scoliosis.
METHODS
A retrospective case-control study.


OBJECTIVE
Evaluate the effectiveness of Amicar in decreasing perioperative blood loss in patients with neuromuscular scoliosis undergoing posterior spinal fusion (PSF) and segmental spinal instrumentation (SSI).


BACKGROUND
Previously, a preliminary prospective; prospective randomized double-blind; same-day anterior and posterior spinal fusion; and fibrinogen studies have demonstrated Amicar to be effective in decreasing total perioperative blood loss and transfusion requirements in surgery for idiopathic scoliosis. Increased fibrinogen secretion is a possible explanation. We are now analyzing its effectiveness in neuromuscular scoliosis.


METHODS
Amicar was administered at 100 mg/kg over 15 minute not to exceed 5 g after anesthesia induction. Maintenance is 10 mg/kg/h until wound closure. There were 2 study groups: group 1 (n = 34), no Amicar and group 2 (n = 62) who received Amicar. The majority of patients in both groups had cerebral palsy. Total perioperative blood loss was determined from the estimated intraoperative blood loss and measured postoperative suction drainage. Total perioperative blood loss and transfusion requirements (cell saver and allogeneic) were compared using chi or Fisher exact test.


RESULTS
There was statistically less estimated intraoperative blood loss, total perioperative blood loss, and transfusion requirements in group 2. Postoperative suction drainage was also less but did not reach statistical significance. In group 1, estimated intraoperative blood loss, measured postoperative suction drainage, and total perioperative blood loss were 2194 +/- 1626 mL, 903 +/- 547 mL, and 3055 +/- 1852 mL, whereas in group 2, it was 1125 +/- 715 mL, 695 +/- 489 mL, and 1805 +/- 940 mL. Transfusion requirements were 1548 +/- 962 mL in group 1 but only 660 +/- 589 mL in group 2 (P < 0.0001). Amicar was equally effective in all diagnoses. There were no complications related to the use of Amicar.


CONCLUSIONS
Amicar was highly effective in decreasing perioperative blood loss and transfusion requirements in patients with neuromuscular scoliosis undergoing PSF and SSI. It was most effective in decreasing estimated intraoperative blood loss. This results in decreased transfusion requirements, costs, and potential transfusion-related complications.
Thompson
George H
GH
Division of Pediatric Orthopaedics, Rainbow Babies and Children's Hospitals, University Hospitals/Case Medical Center, Case Western Reserve University, Cleveland, OH 44106, USA. ght@po.cwru.edu
Florentino-Pineda
Ivan
I
Poe-Kochert
Connie
C
Armstrong
Douglas G
DG
Son-Hing
Jochen
J
D000293:Adolescent; D015119:Aminocaproic Acid / Q000009:adverse effects / Q000627:therapeutic use*; D000933:Antifibrinolytic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D016063:Blood Loss, Surgical / Q000517:prevention & control*; D001803:Blood Transfusion; D016022:Case-Control Studies; D002648:Child; D005260:Female; D006801:Humans; D008297:Male; D009468:Neuromuscular Diseases / Q000150:complications* / Q000601:surgery; D019106:Postoperative Hemorrhage / Q000209:etiology / Q000517:prevention & control*; D012189:Retrospective Studies; D012600:Scoliosis / Q000209:etiology / Q000601:surgery*; D013123:Spinal Fusion / Q000009:adverse effects* / Q000295:instrumentation; D013396:Suction; D016896:Treatment Outcome; D055815:Young Adult
D000933:Antifibrinolytic Agents; D015119:Aminocaproic Acid