Clinical Outcome Of Local Injection In Incision With Cocktailanalgesic Combined With Tranexamic Acid For Pain And Blood Management After Posterior Lumbar Fusion Surgery

Objective To assess the effectiveness and safety of cocktail analgesic combined with tranexamic acid for local application in posterior lumbar fusion surgery.Methods From December 2017 to June 2018,90 patients with lumbar degenerative diseases(lumbar disc herniation,lumbar spondylolisthesis and lumbar spinal stenosis)who met the inclusion and exclusion criteria were collected and divided into cocktail group and control group randomly according to the random number table method.Each patient underwent posterior lumbar interbody fusion(PLIF).In the cocktail group,cocktail analgesic combined with tranexamic acid solution was injected locally before the incision closed,and patient-controlled intravenous analgesia(PCIA)pump was not used after operation;in the control group,normal saline was injected locally before incision closed,and patient-controlled intravenous analgesia(PCIA)pump was used routinely after operation.Visual analogue score(VAS),total blood loss(TBL),intraoperative blood loss(IBL),postoperative blood loss(PBL),hidden blood loss(HBL),hemoglobin(HB),hematocrit(HCT),tramadol requirement dosage,activated partial thromboplastin time(APTT),prothrombin time(PT),International Normalized Ratio(INR),D-Dimer(D-D)and blood transfusion rate were compared between the two groups.Observed and recorded the postoperative complications,including postoperative nausea and vomiting(PONV),adverse reactions of blood transfusion,deep vein thrombosis(DVT),pulmonary embolism(PE),incision hematoma and incision infection.Results There was no significant difference in VAS between the cocktail group and the control group at 0h,6h,12h,24h and 48h after wakefulnes(P>0.05),but the tramadol requirement of the cocktail group was significantly lower than that of the control group(P<0.05).Compared with control group,the Hb level of cocktail group on the 1st day after operation had no significant difference(P>0.05),but the Hb level of cocktail group on the 3rd day after operation was significantly higher than that of the control group(P<0.05).There was no significant difference in IBL between the cocktail group and the control group(208.7±56.2ml vs200.9±41.4ml,P=0.457);the TBL,PBL and HBL of the cocktail group were significantly lower than those of the control group(636.8±247.3ml vs908.8±232.0ml,64.8±24.3ml vs 113.6±25.7ml,363.3±239.2ml vs594.3±224.5ml,P=0.000).There was no significant difference in APTT,PT,INR and D-D between the two groups(P>0.05).In the control group,there were 13 patients occured postoperative nausea and vomiting,while in the cocktail group,there was no patients occured postoperative nausea and vomiting,the difference was statistically significant(χ~2=15.195,P=0.000);There were no blood transfusion,DVT,PE,incision hematoma and incision infection occured in the two groups,and no toxic reaction of ropivacaine in the cocktail group.Conclusion Local application of cocktail analgesic combined with tranexamic acid in posterior lumbar fusion surgery can relieve postoperative pain and reduce postoperative bleeding safely and effectively,which has clinical promotion value.