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

Abstract

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 60µg versus 27µg). 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.

Different Dose Regimens of Intravenous Tranexamic Acid in Adolescent Spinal Deformity Surgery: A Systematic Review and Meta-Analysis

“…Based on the inclusion and exclusion criteria, the full text of the remaining 34 articles was evaluated for eligibility. Finally, 6 RCTs and 11 non-RCTs were included in this meta-analysis [ 4 , 5 , 7 – 21 ]. Figure 1 is a flow diagram of the study selection.…”

“…Six RCTs and 11 non-RCTs involving 1148 patients were analyzed in this meta-analysis [ 4 , 5 , 7 – 21 ]. All included studies were published between 2001 and 2019 [ 4 , 5 , 7 – 21 ]. The characteristics of all included studies are shown in Table 1 .…”

“…The efficacy and safety of different dose regimens of IV TXA in adolescent spinal deformity surgery had been compared in all studies. A total of 9 studies were high-dose regimens [ 4 , 5 , 8 – 10 , 15 – 17 , 19 ], and the remaining 8 studies were low-dose regimens [ 7 , 11 – 14 , 18 , 20 , 21 ]. Of these 9 studies, 3 studies were RCTs [ 5 , 8 , 10 ], and the rest were non-RCTs [ 4 , 9 , 15 – 17 , 19 ].…”

“…Among these studies with the high-dose regimen, there are 6 studies with the same dose regimen, all with a loading dose of 100 mg/kg infused before skin incision and a maintenance dose of 10 mg/kg/h [ 8 , 9 , 15 – 17 , 19 ]. Of these 8 studies, 3 studies were RCTs [ 7 , 13 , 21 ], and the rest were non-RCTs [ 11 , 12 , 14 , 18 , 20 ]. Among them, there are 4 studies with the same dose regimen, all with a loading dose of 10 mg/kg infused before skin incision and a maintenance dose of 1 mg/kg/h [ 7 , 13 , 18 , 21 ].…”

Efficacy of Dexmedetomidine Infusion Without Loading Dose as a Potent Hypotensive Agent in Lumbar Fixation Surgery

“…Continuous infusion at a rate of 1 mg/kg/h was administered after skin incision till the end of the surgical procedure. This dosing regimen followed current literature and guidelines [7].…”