Comparison of aprotinin and tranexamic acid in adult scoliosis correction surgery.

PURPOSE: A retrospective review of consecutive adult patients undergoing scoliosis correction surgery was performed to compare the effects of aprotinin and tranexamic acid in blood conservation and to define a comprehensive blood conservation strategy for such surgery. METHODS: Medical records of all patients who underwent scoliosis correction surgery in this unit between January 2003 and December 2008 were reviewed. The patients were divided into three cohorts: group 1 receiving no antifibrinolytics, group 2 aprotinin and group 3 tranexamic acid. Information was collected regarding number of vertebral levels fused, pre- and post-operative haemoglobin, intra-operative blood loss and peri-operative autologous and allogenic blood transfusion performed. RESULTS: Aprotinin was used in 28 patients (38%), tranexamic acid in 26 (36%), while 19 (26%) received no antifibrinolytics. 21 patients had anterior surgery, 34 patients had posterior surgery and 18 had combined anterior and posterior procedures. Mean blood loss in the patients who received aprotinin and tranexamic acid was 710 and 738 ml, respectively. This was significantly less than the patients receiving no antifibrinolytics (972 ml, p = 0.037). Blood transfusion was required in only two patients undergoing anterior correction surgery. CONCLUSION: Aprotinin and tranexamic acid reduce blood loss in adult spinal deformity correction surgery. With aprotinin being unavailable for clinical use, we recommend the use of tranexamic acid along with other blood conservation measures for adult spinal deformity correction surgery.

Opioid-sparing effects of diclofenac and paracetamol lead to improved outcomes after cardiac surgery.

OBJECTIVE: This study assessed the analgesic efficacy, side effects, time to extubation, and oxygenation of 3 analgesic regimens after coronary artery bypass surgery using diclofenac, paracetamol, and placebo suppositories. DESIGN: Prospective, randomized, double-blind, placebo-controlled study. SETTING: Referral center for cardiothoracic surgery at a university hospital. PARTICIPANTS: Sixty consenting adults scheduled for elective coronary artery bypass grafting (CABG). INTERVENTIONS: Patients were divided into 3 groups postoperatively: diclofenac/paracetamol: diclofenac, 100 mg rectally, and paracetamol, 1 g rectally. Diclofenac was repeated after 18 hours and paracetamol every 6 hours for 24 hours; diclofenac: diclofenac as in diclofenac/paracetamol, with placebos replacing paracetamol; and placebo: 2 placebo suppositories at same times as diclofenac/paracetamol. All patients received morphine patient-controlled analgesia. RESULTS: Twenty-four hour morphine consumption with diclofenac/paracetamol was 12 +/- 6 mg, diclofenac 22 +/- 13 mg, and placebo 37 +/- 15 mg (diclofenac/paracetamol and diclofenac, p = 0.0003 and p = 0.0159 compared with placebo). Patients in the placebo group had significantly greater pain scores at 12 and 24 hours compared with diclofenac/paracetamol and diclofenac. Extubation time was significantly prolonged in the placebo group compared with the diclofenac/paracetamol and diclofenac groups (mean [SD] minutes diclofenac/paracetamol, diclofenac, and placebo 478 [150], 487 [257], and 710 [326], respectively). Oxygenation following extubation was significantly lower in the placebo group compared with the diclofenac/paracetamol and diclofenac groups (mean [SD] mmHg: diclofenac/paracetamol, diclofenac, and placebo 175 [44], 157 [43], and 117 [22], respectively). Episodes of nausea and vomiting were significantly less in the diclofenac/paracetamol and diclofenac groups than in the placebo group (46% and 51% reduction, respectively). all groups had similar blood loss and change in serum creatinine. CONCLUSION: Diclofenac alone or with paracetamol has a significant opioid-sparing effect after CABG, producing more rapid extubation and better oxygenation.