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Blood-sparing efficiency of transdermal nitroglycerine during open fixation of femur shaft fractures: a randomized,
Asif Perviz Kazemi1, Farid Zand, Masoomeh Sedaghat
1Department of Anesthesiology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran.
Study Objectives:
To evaluate the effect of transdermal nitroglycerine for reducing blood loss during open fixation of femur shaft fractures.
Design:
Randomized, double blind, clinical trial.
Setting:
University-affiliated hospital.
Patients:
60 ASA physical status I and II patients undergoing elective open fixation of femur shaft fractures.
Interventions:
Patients were randomized to two groups: those who received 3-in (7.5 cm) transdermal nitroglycerine (group N) or 3-in (7.5 cm) placebo (group P). All the drugs used for induction and maintenance of anesthesia were similar in both groups and administered according to the patient's weight.
Measurements:
In both groups, baseline heart rate and blood pressure were recorded and then measured every 5 minutes thereafter. Routine estimation, as well as a mathematical model of blood loss calculation, was used to determine intraoperative blood loss.
Main Results:
Group N had a significant lower systolic, diastolic, and mean arterial blood pressure than those of group P during the operation. The mean estimated blood loss in group N (443.4 +/- 158.0 mL) was significantly lower than that in group P (950.0 +/- 554.9 mL). The calculated blood loss (622.7 +/- 192.4 mL) in group N was also significantly lower than that in group P (1232.1 +/- 630.4 mL).
Conclusion:
By inducing moderate hypotension, the use of transdermal nitroglycerine decreases intraoperative blood loss and the need for transfusion.