Effect of prophylactic tranexamic acid on blood conservation in Indian women undergoing abdominal hysterectomy

Background: The prevalence of anemia in India is so high that majority of women presenting for hysterectomy are already with borderline hemoglobin status and the perioperative blood loss puts them at risk of death and prolongs recovery. Antifibrinolytic agents, mainly Tranexamic acid (TXA) have been demonstrated to reduce blood loss and transfusion requirements in various surgeries. The present study was done to assess the efficacy of TXA in effectively reducing intraoperative blood loss and the need for transfusion in Indian population undergoing abdominal hysterectomy for benign indications.Methods: This randomized, double-blind, placebo-controlled study was conducted on hundred patients undergoing abdominal hysterectomy. Group T (n = 50)- received TXA 15 mg/kg in 100 ml Normal saline and Group N (n = 50)-received the same volume of Normal saline infused over 15 minutes. Estimated blood loss need for blood transfusion, duration of surgery, postoperative hemoglobin and incidence of adverse events were noted.Results: There was statistically significant reduction in mean blood loss in group T when compared to group N (360 ml versus 540 ml). Accordingly, there was significant difference in the number of patients requiring blood transfusion (12% versus 42%) and also the postoperative hemoglobin levels. The group T patients had a significantly shorter operating time (127.86 versus 148.64 minutes). None of the patients developed any major adverse events.Conclusions: The prophylactic TXA safely and effectively reduces the blood loss and transfusion requirements in Indian patients undergoing abdominal hysterectomy for benign indications

Comparison of active versus expectant management on fetomaternal outcome in patients with placenta previa

Background: Placenta previa is one of the leading cause (31%) of obstetric hemorrhage. It accounts for significant maternal and perinatal morbidity and mortality. The objective of the present investigation was to compare the effect of active management versus expectant management on maternal and fetal outcome in patients with placenta previa.Methods: This randomized prospective cohort study was conducted on 100 Patients of 32 weeks to 36 weeks of gestation with diagnosis of Placenta previa. Selected patients were randomly divided into Group A- Active management and Group B - Expectant management.Results: In both the groups, majority of women were in the age group of 26-30 years and were multigravidas. The need for blood transfusion and the mode of delivery were similar in both the groups. Group A had higher incidence of PPH (22% vs 10%) and peripartum hysterectomy (18% vs 2%) when compared to group B. The maternal deaths were more in group A (4% vs 2%). Majority of the babies born to group A mothers had a low Apgar, birth weight below 2 kgs and greater NICU admission. The perinatal deaths were more in group A (16% vs 2%) and the difference was statistically significant.Conclusions: The expectant management protocol was concluded to be a better mode of management protocol in patients with placenta praevia, who are either asymptomatic or with mild to moderate bleeding

Does prophylactic tranexamic acid reduce blood loss in Indian women following vaginal delivery?

Background: Postpartum hemorrhage (PPH) accounts for 25% to 33% of obstetric deaths every year. Anemia is a cause and consequence of PPH. Despite intense efforts to prevent anemia, many Indian women labour with low hemoglobin levels. Tranexamic acid (TXA), an antifibrinolytic, have been demonstrated to reduce blood loss and transfusion requirements in various surgeries including cesarean section. Objectives were to study the efficacy of TXA in effectively reducing blood loss in Indian women following vaginal delivery.Methods: This randomized, double-blind, placebo-controlled study was conducted on 200 patients scheduled for vaginal delivery. In addition to oxytocin 10 units, group T received TXA 15 mg/kg and group P received normal saline administered over 5 minutes. Estimated blood loss, Hemoglobin deficit, need for additional uterotonics, need for blood transfusion, incidence of PPH and adverse events were noted.Results: The fall in hemoglobin was significantly higher in group P (p<0.00001). Estimated 24 hour blood loss was significantly higher by a mean blood volume of 86.99 ml in group P compared to group T (p<0.00001). The incidence of PPH was lower in group T (2.8% versus 11.3%). There were no significant difference in the need for supplementary uterotonics (9.9% versus 15.5%) and the incidence of blood transfusion (2.8% versus 8.5%). No adverse maternal and fetal outcomes were noted.Conclusions: To reduce blood loss following vaginal delivery, TXA may be safely recommended as standard adjunct to Oxytocin for regular management of third stage of labour, especially in developing countries like India

Comparative study of continuous surgical transverse abdominis plane block versus intravenous fentanyl infusion for postoperative pain management in open nephrectomy

Background: Role of continuous infusion of local anesthetic drug in the transverse abdominal plane using a catheter inserted during the surgical closure of the wound has not been evaluated as a “sole technique” in patients undergoing open nephrectomy. Thus we designed this prospective, randomized comparative study to evaluate this aspect. Aim and Objectives: To compare the efficacy of continuous surgical transverse abdominal plane block with intravenous fentanyl infusion in open nephrectomies. The primary outcomes were post-operative tramadol consumption, pain at rest and pain while coughing. The secondary outcomes were the level of sedation, time to mobilize, and the incidence of wound infection. Material and Methods: Fifty patients undergoing elective open nephrectomy were randomly divided into two equal groups to either receive intravenous fentanyl infusion (Group A), or continuous infusion of bupivacaine in the transversus abdominis plane through a surgically inserted catheter (Group B). The independent sample t-test was applied for numerical variables, while one way Analysis of Variance (ANOVA) repeated measure was used for analyzing the continuous variables. Chi-square and Fisher's exact tests were the tools used for analyzing the dichotomical variables. Results: Tramadol consumption, pain while resting, and pain during coughing were significantly lower in Group B (p<0.001, p=0.003, p=0.001 respectively). Level of sedation and time to mobilize were also significantly lower in patients of Group B. Adverse effects were not differing significantly between groups. No wound infection was noted in either group. Conclusion: Continuous surgical wound infusion of 0.25% bupivacaine through a catheter placed by the surgeon in the transverse abdominal plane in open nephrectomy patients can be considered as an effective and safe alternative of providing postoperative pain relief than intravenous fentanyl infusion