TXA induces pain during surgery for AIS
Tranexamic acid (TXA) administered during surgery for adolescent idiopathic scoliosis (AIS) evokes pain, requiring an increased infusion rate of remifentanil, a new study reports.
Researchers obtained records of AIS patients who received posterior spinal fusion surgery with pedicle screw constructs. Those older than 18 years at the time of surgery and who received the anterior procedure surgery were excluded.
Patients were stratified into two, according to whether they received intraoperative TXA or not. The primary outcome of the study was the infusion rate of intraoperative remifentanil, which was assumed to reflect pain reception during surgery.
Of the 75 patients included in the study, 42 received intraoperative TXA and 33 did not. Surgical data showed that the duration of the surgery and anaesthesia was significantly shorter in the TXA group compared with the control group (p<0.0001).
Similarly, the total volume of blood loss and intravascular fluid were significantly lower in the TXA group compared with the control group (p<0.0001). Moreover, patients who received TXA also required higher doses of ketamine and fentanyl compared with controls (p<0.05).
The mean infusion rate of intraoperative remifentanil was significantly higher in the TXA group (0.28±0.12 μg/kg/min) than in the control group (0.23±0.04 μg/kg/min; p=0.014).
In terms of ephedrine and phenylephrine consumption, haemoglobin levels and haemodynamic parameters, no difference between the groups was observed. No intra- and postoperative complications associated with TXA were observed.
The study highlights a new adverse event associated with TXA use and will help practitioners gauge the adequate dosage of TXA in surgeries.