Effect of tranexamic acid on reducing postoperative blood loss in combined hypotensive epidural anesthesia and general anesthesia for total hip replacement

Study 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. Design: Prospective, randomized, double-blinded trial. Setting: University-affiliated hospital. Patients: 68 adult, ASA physical status 1 and 2 patients undergoing primary unilateral cementless total hip replacement with general anesthesia and HEA. Interventions: 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. Measurements: 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. Main Results: There was no significant difference in intraoperative blood loss between the BEA 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 BEA 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. (c) 2013 Elsevier Inc. All rights reserved.