title: Effect of tranexamic acid on reducing postoperative blood loss in combined hypotensive epidural anesthesia and general anesthesia for total hip replacement.
abstract: OBJECTIVE
  To determine whether the use of tranexamic acid in the setting of hypotension induced by hypotensive epidural anesthesia (HEA) has any additional beneficial effects in reducing perioperative blood loss and transfusion requirements in total hip replacement.
  
  
  METHODS
  Prospective, randomized, double-blinded trial.
  
  
  METHODS
  University-affiliated hospital.
  
  
  METHODS
  68 adult, ASA physical status 1 and 2 patients undergoing primary unilateral cementless total hip replacement with general anesthesia and HEA.
  
  
  METHODS
  The HEATA group received a bolus dose of 15 mg/kg of tranexamic acid before surgical incision, followed by a continuous 15 mg/kg infusion until skin closure. The HEA group received normal saline instead of tranexamic acid in the same manner.
  
  
  METHODS
  Intraoperative blood loss was measured using the difference between the weights of used gauze and the original unused gauze, in addition to the blood volume accumulated in suction bottles. Postoperative blood loss was considered to be the amount of blood accumulated in drainage bags.
  
  
  RESULTS
  There was no significant difference in intraoperative blood loss between the HEA and HEATA groups (251.8 ± 109.9 mL vs. 234.9 ± 93.9 mL), but postoperative blood loss was significantly less in the HEATA group than the HEA group (439.3 ± 171. 6 mL vs. 1074.4 ± 287.1 mL), as was total cumulative blood loss (674.2 ± 216.4 mL vs. 1326.2 ± 347.8 mL). There was no significant difference in intraoperative transfusion incidences, but postoperative transfusion was greater in the HEA group than the HEATA group.
  
  
  CONCLUSIONS
  Administration of tranexamic acid combined with hypotensive epidural anesthesia reduced postoperative and total accumulative blood loss and transfusion requirements more than did hypotensive epidural anesthesia alone.
authors: Department of Anesthesiology and Pain Medicine, Keimyung University, School of Medicine, Daegu, 700-712, Korea. Electronic address: yclee@dsmc.or.kr.
authors: Yong-Cheol
authors: YC
authors: Lee
authors: Department of Anesthesiology and Pain Medicine, College of Medicine, Yeungnam University, Daegu, 705-717, Korea.
authors: Sang-Jin
authors: SJ
authors: Park
authors: Department of Anesthesiology and Pain Medicine, Keimyung University, School of Medicine, Daegu, 700-712, Korea.
authors: Ji-Seob
authors: JS
authors: Kim
authors: Department of Orthopedic Surgery, Keimyung University, School of Medicine, Daegu, 700-712, Korea.
authors: Chul-Hyun
authors: CH
authors: Cho
mesh_terms: D000328:Adult; D000767:Anesthesia, Epidural / Q000379:methods; D000768:Anesthesia, General / Q000379:methods; D000933:Antifibrinolytic Agents / Q000008:administration & dosage / Q000627:therapeutic use; D019644:Arthroplasty, Replacement, Hip / Q000379:methods*; D016063:Blood Loss, Surgical / Q000517:prevention & control*; D001803:Blood Transfusion / Q000379:methods; D004311:Double-Blind Method; D005260:Female; D006785:Hospitals, University; D006801:Humans; D007023:Hypotension, Controlled / Q000379:methods; D008297:Male; D008875:Middle Aged; D019106:Postoperative Hemorrhage / Q000517:prevention & control*; D011446:Prospective Studies; D014148:Tranexamic Acid / Q000008:administration & dosage / Q000627:therapeutic use*
chemical_list: D000933:Antifibrinolytic Agents; D014148:Tranexamic Acid
keywords: Blood loss: surgical; Hypotensive epidural anesthesia; Total hip replacement; Tranexamic acid