Management of spasticity in children with cerebral palsy.

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Abstract

[Indexed for MEDLINE] 12. Syst Rev. 2024 Dec 27;13(1):315. doi: 10.1186/s13643-024-02734-7. Tranexamic acid in hip and spine surgery for children with cerebral palsy - a PRISMA-compliant scoping review. Gould D(1), Cui H(2), Ma N(3), Chalkiadis G(4), Davidson A(5), Graham K(5), Rutz E(5)(6)(7)(8)(9). Author information: (1)Department of Paediatrics, The Royal Children's Hospital, University of Melbourne, 50 Flemington Road, Parkville, VIC, 3052, Australia. daniel.gould@unimelb.edu.au. (2)Monash Medical Centre, 246 Clayton Rd, Clayton VIC 3168, Melbourne, Australia. (3)Alfred Health, 55 Commercial Rd, Melbourne VIC 3004, Australia. (4)Department of Anaesthesia and Pain Management, Royal Children's Hospital, 50 Flemington Road, Parkville VIC 3052, Melbourne, Australia. (5)Department of Paediatrics, The Royal Children's Hospital, University of Melbourne, 50 Flemington Road, Parkville, VIC, 3052, Australia. (6)Department of Orthopaedics, The Royal Children's Hospital, Melbourne, 3052, Australia. (7)Murdoch Children's Research Institute, Melbourne, 3052, Australia. (8)Department of Paediatrics, Bob Dickens Chair, Paediatric Orthopaedic Surgery, The University of Melbourne, Melbourne, 3010, Australia. (9)Medical Faculty, University of Basel, Basel, 4001, Switzerland. Many children with cerebral palsy (CP) are frail and require major hip and/or spine surgeries associated with substantial blood loss. Tranexamic acid (TXA) is commonly used to reduce blood loss, but there is uncertainty around the optimal dose and timing of administration. There have been reviews in sub-populations and specific dosing regimens, but a broad overview of the available literature is lacking. The aim of this review was to map available evidence on TXA in hip and spine surgery for children with CP. Given the heterogeneous literature, a prospectively registered scoping review was conducted. Eligibility criteria were broad. Three screeners were involved, with the senior author consulted when disagreements were not resolved through discussion.Titles and abstracts of 14,609 records were screened, with 52 records included. Two additional records were obtained from grey literature and citation searching. Cohort studies (50.0%) were the most common. Most records (76.9%) were on spine surgery. TXA dose varied widely. Loading doses range from 5 to 100 mg/kg and intraoperative infusions from 1 to 10 mg/kg/h. Dose was not reported in 35.2% of records. Primary outcome measures included blood loss and transfusion requirements. TXA was generally reported to be safe. None of the included records reported postoperative TXA administration.While TXA is generally considered safe, there was mixed evidence on efficacy. Much of the evidence was drawn from studies in which TXA was used in patients at higher risk of bleeding or with reduced physiological reserve. There was no evidence for TXA being used postoperatively, when a large proportion of transfusions occur. © 2024. The Author(s). DOI: 10.1186/s13643-024-02734-7 PMCID: PMC11673357