Effects Of Ketoolac Aminobutyltriol And Parecoxib Sodium On Postoperative Blood Loss In Patients Undergoing Transforaminal Lumbar Interbody Fusion

Objective:To evaluate the effect of ketorolac aminobutyltriol and parecoxib sodium on postoperative blood loss in patients undergoing transforaminal lumbar interbody fusion(TLIF).Methods:A retrospective analysis was performed on 59 cases of single level lumbar spinal stenosis patients receiving single level TLIF From February 2018 to February 2019 at Northern Jiangsu people’s Hospital were retrospectively collected into this study.Patients were were randomly divided into ketorolac tromethamine group(n=31)and parecoxib sodium group(n=28).After operation,ketorolac tromethamine group was given ketorolac tromethamine 30 mg ivgtt bid for 3 consecutive days,and parecoxib sodium group was given parecoxib sodium 40mg iv bid for 3 consecutive days.General data,operation time,intraoperative blood loss,postoperative drainage volume,total blood loss were compared between the two groups,dominant blood loss,and hidden blood loss.Meanwhile,we compared the hemocytoanalysis,blood coagulation function,liver and kidney function at Pre-operation and post-operation between groups.Visual analog score(VAS)at Pre-operation 24h,48h 72h,Oswestry dysfunction index(ODI)and Japanese orthopaedic association Scores(JOA)at preoperative period,post-operative 1 week,1 month and lyear were compared between groups.The independent sample t test was used to compare the measurement data between the two groups with normal distribution.Chi-square test was used for the enumeration data(gender,hypertension,diabetes,surgical level).P<0.05 was considered statistically significant.Results:All patients completed the operation successfully,and all 57 patients were followed up.Gender,age,body mass index(BMI),underlying diseases,surgery segment were compared.At ketorolac tromethamine group,the average surgery time was 125.5±35.7 min,the average intro-operative blood loss was 2 75.2±103 mL,the average total blood loss was 1191.7±382.9 mL,the average drainage volume was 419.0±145.6 mL,the revealed blood loss was 694.2±192mL and the average hidden blood loss was 497.5±391.2 mL.As for parecoxib sodium group,the average surgery time was 128.4±38.0 min,the average intro-operative blood loss was 258.2±80.5 mL,the average total blood loss was 994.0±275.8 mL,the average drainage volume was 341.1±82.4 mL,the revealed blood loss was 599.3±124.7 mL and the average hidden blood loss was 394.8±277.4 mL.Total blood loss,revealed blood loss and drainage volume were significantly decreased at parecoxib sodium group when compared to ketorolac tromethamine group.There showed similar results at hidden blood loss between groups without significance.Meanwhile,hematocrit,platelet,alanine aminotransferase,aspartate aminotransferase,creatinine,urea nitrogen at 2 groups showed similar results without significance.On the contrary,postoperative prothrombin time and partially activated thrombin time at parecoxib sodium group were significantly shortened when compared to ketorolac tromethamine group.The average VAS scores at postoperative 24h,48h and 72h were 3.77±0.81、2.45±0.51 and 2.03±0.66 at ketorolac tromethamine group and 3.61±0.74、2.43±0.57、1.93±0.54 at parecoxib sodium group respectively.The VAS scores at parecoxib sodium group were significantly lower than etorolac tromethamine group at postoperative 24h,48h and 72h period(P<0.05).The JOA scores at postoperative 1 week,1 month and 12 months were showed similar results without significance between groups at different postoperative periods.Conclusion:Parecoxib sodium can reduce total blood loss,dominant blood loss and drainage volume after TLIF surgery.However,parecoxib sodium is not helpful to reduce the hidden blood loss.Hematocrit,platelet,alanine aminotransferase,aspartate aminotransferase,creatinine,urea nitrogen at 2 groups showed similar results without significance.On the contrary,post-operative prothrombin time and partially activated thrombin time at parecoxib sodium group were significantly shortened when compared to ketorolac tromethamine group.The results revealed that parecoxib sodium may own lower influence on blood coagulation function.Therefore,in patients with high risk of post-operative blood loss,parecoxib sodium can be a better choice.