The efficacy and safety of topical saline-irrigation with tranexamic acid on perioperative blood loss in patients treated with percutaneous endoscopic interlaminar discectomy

Abstract

Background: Adequate visualization in percutaneous endoscopic interlaminar discectomy (PEID) surgery is essential for the successful completion of lumbar discectomy. However, there is currently no relevant research on the efficacy and safety of adding tranexamic acid (TXA) to the saline irrigation fluid in PEID surgery. To evaluate the efficacy and safety of topical saline-irrigation with TXA for PEID in the treatment of lumbar disc herniation.Methods: Patients who underwent PEID surgery for L5-S1 lumbar disc herniation were divided into two groups. PEID was performed with saline-irrigation fluid containing 0.33 g of TXA per 1 L of saline in the TXA group (n=38) and only saline in the control group (n=51). All PEID surgeries were performed by the same spine surgery team. The hidden blood loss (HBL), intraoperative blood loss (IBL), total blood loss (TBL), amount of fluid used, operation time, visual clarity, hospital stay, blood transfusion rate, coagulation index and complication rate were compared between the two groups.Results: The TBL, HBL, and IBL in the TXA group were significantly lower than those of the control group. The postoperative hemoglobin in the TXA group was significantly higher than that of the control group. Visual clarity was significantly better and operation time was significantly shorter in the TXA group. However, there was no significant difference in postoperative hematocrit, blood coagulation function, amount of fluid used, blood transfusion rate and perioperative complications between the two groups.Conclusion: In PEID surgery, addition TXA to topical saline-irrigating fluid can significantly reduce HBL, IBL and TBL. Addition TXA to topical saline-irrigating fluid can improve visual clarity in the surgery and reduce operation time, but do not change coagulation function or increase complication rate.