The Open Anesthesia Journal

Formerly: The Open Anesthesiology Journal

ISSN: 2589-6458 ― Volume 13, 2019

Increased Nociception Following Administration of Different Doses of Tranexamic Acid in Adolescent Idiopathic Scoliosis Surgery

Ashraf Nabil Saleh, Raham Hasan Mostafa*
Faculty of Medicine, Ain Shams University, El-hay El-Sabee, Nasr City, Cairo, Egypt



The inhibitory effect of Tranexamic Acid (TXA) on γ-aminobutyric acid and glycine receptors of spinal dorsal horn neurons which leads to pain arousal, has been highlighted recently in animal studies. Such findings would elicit concerns about adverse effects of TXA as a routine agent used to reduce perioperative blood loss.


This study aimed to evaluate the effect of different doses of TXA on analgesic requirements in adolescent patients undergoing elective single-stage posterior spine fusion surgery for idiopathic scoliosis.

Patients and Methods:

This prospective, randomized, double-blinded study comprised 75 patients who were randomly allocated to one of three groups. Each group comprised 25 patients. In group C (Control), patients received normal saline. While in group HD (High Dose), patients received TXA with a loading dose of 50 mg/kg and maintenance dose of 20 mg/kg/h and patients in group LD (Low Dose) received TXA with a loading dose of 10 mg/kg and maintenance dose of 1 mg/kg/h. The total intraoperative fentanyl dose was calculated for each patient which we used as a measure of the patients’ nociception level.


Group HD patients’ required the highest dose of fentanyl compared to those in LD group (mean of 60µg versus 27µg). Patients in group C received no extra intraoperative narcotic doses and experienced the longest duration of surgical procedure. These results showed high statistically significant difference (p < 0.001).


Intraoperative administration of TXA increases the analgesic requirement during elective single stage posterior spine fusion surgery which likely reflects an increase in patients’ intraoperative nociception.

Keywords: Adverse effects, Bleeding, Fentanyl, Idiopathic Scoliosis, Nociception, Tranexamic Acid.

Article Information

Identifiers and Pagination:

Year: 2018
Volume: 12
First Page: 61
Last Page: 68
Publisher Id: TOATJ-12-61
DOI: 10.2174/2589645801812010061

Article History:

Received Date: 28/5/2018
Revision Received Date: 5/9/2018
Acceptance Date: 10/9/2018
Electronic publication date: 28/09/2018
Collection year: 2018

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© 2018 Saleh et al.

open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International Public License (CC-BY 4.0), a copy of which is available at: ( This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

* Address correspondence to this author at the Faculty of Medicine, Ain Shams University, El-hay El-Sabee, Nasr City, Cairo, Egypt; Tel: 002/01222530020; E-mail:


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