Hypotensive Anesthesia Combined with Tranexamic Acid Reduces Perioperative Blood Loss in Simultaneous Bilateral Total Hip Arthroplasty: A Retrospective Cohort Study

Abstract

Objective: To assess the efficacy and safety of hypotensive anesthesia (HA) combined with tranexamic acid (TXA) for reducing perioperative blood loss in simultaneous bilateral total hip arthroplasty (SBTHA). Methods:In this retrospective cohort study, a total of 183 eligible patients (15 females and 168 males, 44.01 AE 9.29 years old) who underwent SBTHA from January 2015 to September 2020 at our medical center were enrolled for analysis. Fifty-nine patients received standard general anesthesia (Std-GA group), the other 85 and 39 patients received HA with an intraoperative mean arterial pressure between 70 and 80 mmHg (70-80 HA group) and below 70 mmHg (<70 HA group), respectively. TXA was administrated to all patients. Perioperative blood loss (total, dominant, and hidden), transfusion rate and volume, hemoglobin and hematocrit reduction, duration of operation and anesthesia, length of hospitalization, range of hip motion as well as postoperative complications were collected from hospital's electronic records and compared between groups.Results: All patients were followed for more than 3 months. Total blood loss in the two HA groups (1390.25 AE 595.67 ml and 1377.74 AE 423.46 ml, respectively) was significantly reduced compared with that in Std-GA group (1850.83 AE 800.73 ml, P < 0.001). Both dominant and hidden blood loss were dramatically decreased when HA was applied (both P < 0.001). Accordingly, the transfusion rate along with volume in 70-80 HA group (14.1%, 425.00 AE 128.81 ml) and <70 HA group (12.8%, 340.00 AE 134.16 ml) were reduced in comparison with those in 690.91 AE 370.21ml; P = 0.001 and P = 0.014, respectively). The maximal hemoglobin and hematocrit reduction in both HA groups were significantly less than those in Std-GA group (both P < 0.001). Of note, 70-80 and <70 HA groups exhibited comparable efficacy with no significant differences between them. Besides, significant difference in duration of surgery was found among groups (P = 0.044 and P < 0.001), while no differences in anesthesia time and postoperative range of hip motion were observed. Regarding complications, the incidence of both acute kidney injury and postoperative hypotension in <70 HA group was significantly higher than that in 70-80 HA and Std-GA groups (P = 0.014 and P < 0.001). Incidence of acute myocardial injury was similar among groups (P = 0.099) and no other severe complications or mortality were recorded.

The Effect of Tranexamic Acid and Controlled Hypotension on Perioperative Blood Loss in Craniosynostosis Surgery

“…In line with the findings of this study, the results of Zhang et al's study also indicated the effectiveness of the combination of CHA and TXA in reducing blood loss and transfusion after the surgery such that the total blood loss and blood transfusion rates in this approach were approximately 30% and 15%, respectively (25). In addition, they stated that Hb and HCT levels were better maintained by administering TXA plus CHA (25). In fact, a faster recovery indicated by the reduced length of hospital stay in the two CHA groups was experienced after the surgery by improving the HCT and Hb levels.…”

“…The study population included all infants that were candidates for craniosynostosis correction surgery and were referred to Imam Hossein Hospital affiliated to Isfahan University of Medical Sciences, from April 2017 to June 2018. In this study, 75 patients were considered as the sample according to the sample size formula in between-groups comparison, at the confidence level of 95%, the test power of 80%, and considering the results of previous studies ( 25 ) reporting the mean and standard deviation of the total blood loss in control and TXA plus CHA groups equal to 1850.83 ± 800.73 ml and 1377.74 ± 423.46 ml, respectively.…”

Effect of tranexamic acid on blood loss reduction in patients undergoing orthognathic surgery under hypotensive anesthesia: a single-center, retrospective, observational study

“…This approach has also been reported to improve the visibility of the surgical field and shorten the operative time 11,12 . Hypotensive anesthesia is mainly used in the fields of orthopedic spine surgery and total hip replacement; however, it is also known to reduce intraoperative blood loss in patients undergoing orthognathic surgery and was also adopted for this study [13][14][15] .…”