| Objective: To investigate the effect of cocktail on blood loss and pain after single-level posterior lumbar interbody fusion and its safety.Methods: Sixty patients with single-segment posterior lumbar interbody fusion in the spine surgery department of Xiangtan Central Hospital from January 20 to February 2019 were selected as subjects and randomly divided into two groups according to the random number table method.Group A(experimental group):20ml cocktail(2g tranexamic acid + 1:200,000 epinephrine 0.25 mg + 1% ropivacaine 100 mg,diluted with normal saline(NS)into 50ml)was injected around the incision before suturing deep fascia layer and immersed in 30 ml for 10 minutes;Group B(control group)was treated with the same method during operation;one drainage tube was placed in both groups after operation.The 24-hour drainage volume and total drainage volume,hemoglobin(HB),hematocrit(Hct)and dimer values 1 day before and 1 day and 3 days after operation,VAS pain scores 4 hours,8 hours,12 hours,24 hours and 48 hours after operation,changes of heart rate,blood pressure and heart rate and blood pressure immediately,5 minutes,10 minutes and 30 minutes after intervention,color Doppler ultrasonography of lower extremities and adverse events after operation were observed.The average follow-up time was 6 months.Result:1.There was no significant difference in gender,age,height,weight,preoperative HB,preoperative Hct and preoperative D-dimer between the two groups(P > 0.05).The data of the two groups were comparable.There was no significant difference in the number of cases of hypertension,coronaryheart disease,diabetes mellitus and cerebrovascular disease and operation time between the two groups(P > 0.05).2.Effectiveness results2.1.Postoperative drainage: 24-hour drainage and total drainage of A and B group were 92.00(+19.32 ml)and 167.33(+5.69ml)VS 225.50(+54.59 ml)and 355.00(+69.88 ml),respectively,with significant difference(P < 0.05);the average intraoperative blood loss of A and B group was 228.67(+60.73 ml)and 252.00(+60.31 ml),respectively,with no significant difference(P > 0.05).There was no blood transfusion after operation in both groups.2.2.Postoperative changes of HB and Hct: HB(g/l)in A and B group were 129.07(+13.05)and 124.57(+13.84)VS 119.17(+13.11)and 112.70(+13.86)on the 1st and 3rd day after operation,respectively,with significant difference(P < 0.05);Hct(%)on the 1st and 3rd day after operation were 37.71(+3.32)and 35.95(+4.12)VS 35.41(+3.63)and 33.68(+3.91),respectively,with significant difference(P < 0.05).The decrease of HB on the third day and Hct on the third day after operation were lower than those in group B,the difference was statistically significant(P < 0.05);there was no significant difference in the decrease of Hct on the first day after operation between the two groups(P > 0.05).2.3.Postoperative VAS pain score: The VAS pain score in group A was lower than that in group B at 4,8 and 12 hours after operation(P < 0.05),and there was no significant difference in VAS pain score at 24 and 48 hours after operation between the two groups.3.Safety results3.1.Heart rate and blood pressure: There was no significant difference in systolic blood pressure,diastolic blood pressure and heart rate between the two groups before and immediately after intervention,5 minutes,10 minutes and 30 minutes(P > 0.05).3.2,Plasma D-dimer value: There was no significant difference in plasma D-dimer value between the two groups on the 1st day before operation and the 1st and 3rd day after operation(P > 0.05).3.3.Adverse events: No lower extremity deep venous thrombosis,wound infection,persistent elevated blood pressure,malignant arrhythmia or stiffness occurred in both groups.Conclusion: Local application of cocktail can effectively reduce the blood loss and early incision pain of PLIF patients,It does not increase the postoperative complications and has good safety. |
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