Blood–sparing efficiency of transdermal nitroglycerine during open fixation of femur shaft fractures: a randomized, double-blind study

Study ObjectivesTo evaluate the effect of transdermal nitroglycerine for reducing blood loss during open fixation of femur shaft fractures.DesignRandomized, double blind, clinical trial.SettingUniversity-affiliated hospital.Patients60 ASA physical status I and II patients undergoing elective open fixation of femur shaft fractures.InterventionsPatients 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.MeasurementsIn 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 ResultsGroup 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).ConclusionBy inducing moderate hypotension, the use of transdermal nitroglycerine decreases intraoperative blood loss and the need for transfusion.