RESUMO
Tranexamic acid (TXA), a potent antifibrinolytic agent, is widely used in cardiac surgical procedures worldwide to minimize surgical bleeding and reduce the need for perioperative blood transfusions. However, the use of TXA may increase the risk of coronary artery graft thrombosis, potentially leading to a higher occurrence of late thrombotic events. Some studies have suggested that drugs like TXA, aimed at decreasing bleeding during cardiac surgeries, may be associated with elevated risks of thrombotic complications or mortality. Conversely, the reduced need for blood transfusions could contribute to improved long-term outcomes. Thus, a systematic review and meta-analysis were undertaken to assess the efficacy of TXA in cardiac surgery patients. Searches were conducted in databases including PubMed and PubMed Central. Data were extracted, and their quality was assessed using the Cochrane risk of bias tool for randomized clinical trials (RCTs). A random effects model was used to compute the pooled prevalence and investigate heterogeneity using the I2 statistic. Subgroup analyses differentiated between experimental and placebo groups. Additionally, sensitivity analyses were performed to assess the robustness of the findings, and publication bias was examined. An overall sample size of 12,869 patients was included in the meta-analysis, derived from seven of the 10 selected articles. This pooled sample was used to conduct an analysis of TXA's efficacy in cardiac surgery patients. Subgroup analysis revealed a 95% heterogeneity and indicated a p-value of less than 0.05, favoring TXA over placebo in terms of better outcomes. Our research indicates a statistically significant relationship between the efficacy of TXA and the number of patients undergoing heart surgery. According to our findings, there is a pressing need to enhance this evidence base and conduct larger RCTs to better understand the benefits of using TXA, aiming to maintain a low risk of bleeding after both major and minor heart surgeries.
RESUMO
Resumen: Introducción: el bloqueo en el plano del músculo erector de la espina (ESPB, por sus siglas en inglés) es un procedimiento seguro, en teoría menos exigente que las técnicas convencionales de anestesia regional torácica. Se utiliza para el tratamiento del dolor agudo y crónico. En la revisión de la literatura, no se encontraron informes de su uso como una técnica única en el dolor agudo de fractura de escápula. Presentación de caso: se reporta un caso clínico de ESPB como técnica experimental para el control del dolor postoperatorio agudo en fracturas de la escápula con aplicación a nivel T2. Se llevó a cabo postoperatorio con disminución de dolor después de 10 minutos de realizado, con una calificación de cero en la escala análoga del dolor. En este caso el ESPB fue realizado en el postoperatorio inmediato, con lo que se logró una disminución total del dolor a los 10 minutos, con posterior control de dolor a las 36 horas. Conclusión: este caso muestra la efectividad de ESPB como técnica experimental para control de dolor postoperatorio en fractura de escápula.
Abstract: Introduction: the erector spine plane block (ESPB) is a safe procedure, technically is less demanding than conventional thoracic regional anesthesia techniques. It is used for the treatment of acute and chronic pain. In the literature review, no reports of its use as a single technique in the acute pain of scapula fracture were found. Case presentation: ESPB is reported in a case as an experimental technique for controlling acute postoperative pain in scapula fractures with an application at the T2 level. It was performed postoperatively with a decrease in pain after 10 minutes and a score of zero on the analog pain scale. In this case, the ESPB was performed in the immediate postoperative period, achieving a total decrease in pain at 10 minutes, with subsequent pain control at 36 hours. Conclusion: this case shows the effectiveness of ESPB as an experimental technique for postoperative pain control in scapula fractures.