# Effect of a Triad of Norepinephrine, Tranexamic Acid, and Endo-Cutter Staplers on the Reduction of Blood Loss and Operative Duration in Patients Undergoing Open Radical Cystectomy

## TL;DR

Using norepinephrine, tranexamic acid, and endo-cutter staplers during bladder cancer surgery reduces blood loss and shortens operation time.

## Contribution

Combining norepinephrine, tranexamic acid, and endo-cutter staplers is shown to significantly reduce blood loss and operative duration in radical cystectomy.

## Key findings

- Intervention group had significantly less intraoperative blood loss (282 mL vs. 502 mL).
- Operative time was reduced by over 2 hours in the intervention group.
- Postoperative hospital stay was shorter by nearly 8 days in the intervention group.

## Abstract

Objective: To evaluate the effect of norepinephrine, tranexamic acid, and endo-cutter staplers on the reduction of blood loss and operative duration in patients undergoing open radical cystectomy (ORC).

Methods: We conducted a prospective case-control study involving 50 patients who underwent ORC. The first group consisted of 25 patients (cases) who received norepinephrine and tranexamic acid-soaked mops, along with endo-cutter staplers for ligating the vascular pedicles during the surgery. The second group comprised 25 patients (controls) who did not receive these interventions. Intraoperative blood loss, blood transfusions, operative time, and perioperative outcomes were evaluated in both groups.

Results: Clinical and tumor characteristics were comparable between the two groups. A significant reduction in mean intraoperative blood loss was observed in the intervention group (282.00±121.74 mL) compared to the control group (502.00±184.54 mL; p=0.000). A significant reduction was also seen in the mean number of blood units transfused (0.24±0.52 vs. 1.32±0.94; p=0.000), the mean fall in hematocrit (2.56±1.09 vs. 7.56±3.27; p=0.003), and the mean intraoperative time (2.89±0.604 hours vs. 5.36±1.295 hours; p=0.000). The mean postoperative hospital stay was significantly shorter in the intervention group (10.16±2.39 days vs. 18.32±8.38 days; p=0.000). No intraoperative complications related to the drugs were noted.

Conclusion: The use of topical norepinephrine, tranexamic acid, and endo-cutter staplers results in a significant reduction in intraoperative blood loss, blood transfusion rates, and operative duration in patients with urothelial bladder cancer undergoing ORC.