Indiana University School of Medicine, Indianapolis, IN.
Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, IN.
J Arthroplasty. 2020 Jun;35(6S):S219-S225. doi: 10.1016/j.arth.2020.01.069. Epub 2020 Jan 31.
Tranexamic acid (TXA) has reduced blood transfusion following total hip arthroplasty (THA). However, non-human studies have linked TXA exposure with increased pain and decreased periarticular cell viability and cell death. This study evaluated early pain following THA performed with and without topical TXA.
A consecutive series of 213 THAs performed without TXA were compared to 169 THAs performed with topical TXA. A single surgeon using identical perioperative medical and pain control protocols performed procedures. Prospectively collected inpatient pain scores, time to first opioid, and opioid consumption in morphine milligram equivalents were evaluated in relation to TXA use and 10 additional covariates. Univariate relationships between independent and dependent variables with P ≤ .20 were entered into multivariate analysis using the General Linear Model.
Patients who received topical TXA reported higher mean 24-hour pain scores compared to patients who did not receive TXA (P = .006). Patients with topical TXA requested opioids significantly sooner (means of 152 vs 246 minutes, P = .033). An average of 56.07 morphine milligram equivalents were consumed during the first 24 hours after post-acute care unit discharge by patients who received topical TXA compared to 31.26 by patients who did not receive TXA (P < .001).
Topical TXA use was associated with greater early postoperative pain and opioid consumption in primary THA patients. Findings were supported by the magnitude of observed effects and the likelihood of clinical relevance. Replication and consideration of potential adverse consequences of TXA use in elective settings is encouraged.
氨甲环酸（TXA）可减少全髋关节置换术（THA）后的输血。然而，非人类研究表明，TXA 暴露与增加疼痛、减少关节周围细胞活力和细胞死亡有关。本研究评估了 THA 中使用和不使用局部 TXA 后的早期疼痛。
将 213 例未使用 TXA 的 THA 与 169 例使用局部 TXA 的 THA 进行连续系列比较。一位使用相同围手术期医疗和疼痛控制方案的单一外科医生进行了手术。前瞻性收集住院患者疼痛评分、首次使用阿片类药物的时间和吗啡毫克当量的阿片类药物消耗，以评估 TXA 使用与 10 个额外协变量之间的关系。使用广义线性模型，将 P ≤.20 的独立和依赖变量之间的单变量关系纳入多变量分析。
接受局部 TXA 的患者报告的 24 小时平均疼痛评分高于未接受 TXA 的患者（P =.006）。接受局部 TXA 的患者要求使用阿片类药物的时间明显更早（分别为 152 分钟和 246 分钟，P =.033）。接受局部 TXA 的患者在急性后护理单元出院后 24 小时内平均消耗 56.07 吗啡毫克当量的阿片类药物，而未接受 TXA 的患者消耗 31.26 吗啡毫克当量的阿片类药物（P <.001）。
在初次 THA 患者中，局部 TXA 的使用与术后早期疼痛和阿片类药物消耗增加有关。观察到的效应幅度和临床相关性的可能性支持了这些发现。鼓励在选择性治疗中复制和考虑 TXA 使用的潜在不良后果。
