Comparison of Tranexamic acid, Remifentanil, and Hydralazine on the bleeding volume during Dacryocystorhinostomy surgery

Abstract

Background: Bleeding in Dacryocystorhinostomy (DRC) limits the surgeon's sight and access. Tranexamic acid, Remifentanil, and Hydralazine reduce intraoperative blood loss. However, no study has been carried out to compare the efficacy of the latter drugs during DCR surgery.

Methods: Ninety healthy candidates for DCR surgery with chronic Dacryocystitis (aging 20-80) were randomly assigned in groups of 30 to receive low doses of Tranexamic acid (TXA) (10 mg/kg with a maximum dose of 1000 mg), Remifentanil (0.1 µ/kg), or Hydralazine (0.1 mg/kg). All drugs were infused over 15 minutes before the initiation of surgery. The primary outcome was the bleeding volume during the surgery and until 2 hours in recovery. This study was approved by the Iranian Registry of Clinical Trials with the code of IRCT20210614051574N10 (https://en.irct.ir/trial/62759).

Results: Thirty patients (mean age ± SD: 50.48±13.4) were investigated. Mean blood loss volume was lower in Remifentanil and Hydralazine groups compared with the TXA group (P<0.05); there was no significant difference (P>0.05) in bleeding volume between Remifentanil and Hydralazine groups (Tranexamic acid group: 146.83±91 ml, Remifentanil group: 77.6±52.1 ml, Hydralazine group: 80.0±48.7 ml, 95% confidence interval, P<0.05).

Conclusion: Our results show that Remifentanil and Hydralazine are more effective than Tranexamic acid in bleeding control.

Keywords: Blood loss; dacryocystorhinostomy; hemorrhage; induced hypotension.

Figure 1

Systolic blood pressure between the three study groups. 1: before the surgery, 2: 15 min during surgery, 3: 30 min during surgery, 4: 45 min during surgery, 5: 60 min during surgery, 6: 75 min during surgery, 7: at the moment of recovery entry, 8: 15 min in recovery, 9: 30 min in recovery, 10: 45 min in recovery, 11: 60 min in recovery.

Figure 2

Diastolic blood pressure between the three study groups. 1: before the surgery, 2: 15 min during surgery, 3: 30 min during surgery, 4: 45 min during surgery, 5: 60 min during surgery, 6: 75 min during surgery, 7: at the moment of recovery entry, 8: 15 min in recovery, 9: 30 min in recovery, 10: 45 min in recovery, 11: 60 min in recovery.

Figure 3

MAP between the three study groups. 1: before the surgery, 2: 15 min during surgery, 3: 30 min during surgery, 4: 45 min during surgery, 5: 60 min during surgery, 6: 75 min during surgery, 7: at the moment of recovery entry, 8: 15 min in recovery, 9: 30 min in recovery, 10: 45 min in recovery, 11: 60 min in recovery.

Figure 4

Heart rate between the three study groups. 1: before the surgery, 2: 15 min during surgery, 3: 30 min during surgery, 4: 45 min during surgery, 5: 60 min during surgery, 6: 75 min during surgery, 7: at the moment of recovery entry, 8: 15 min in recovery, 9: 30 min in recovery, 10: 45 min in recovery, 11: 60 min in recovery.

Figure 5

SPO₂ between the three study groups. 1: before the surgery, 2: 15 min during surgery, 3: 30 min during surgery, 4: 45 min during surgery, 5: 60 min during surgery, 6: 75 min during surgery, 7: at the moment of recovery entry, 8: 15 min in recovery, 9: 30 min in recovery, 10: 45 min in recovery, 11: 60 min in recovery.